Provider Demographics
NPI:1093029928
Name:ARIC D ROBERTSON OD PLLC
Entity Type:Organization
Organization Name:ARIC D ROBERTSON OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-855-2132
Mailing Address - Street 1:5318 S CASCADE PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4549
Mailing Address - Country:US
Mailing Address - Phone:231-855-2132
Mailing Address - Fax:
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7689
Practice Address - Country:US
Practice Address - Phone:509-735-3128
Practice Address - Fax:509-736-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60167669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty