Provider Demographics
NPI:1114983921
Name:SCHUTT, ROBIN L (OD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:SCHUTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S BURLINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5915
Mailing Address - Country:US
Mailing Address - Phone:402-463-3937
Mailing Address - Fax:402-463-3942
Practice Address - Street 1:220 S BURLINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5915
Practice Address - Country:US
Practice Address - Phone:402-463-3937
Practice Address - Fax:402-463-3942
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110249687Medicaid
NE37196OtherBLUE CROSS BLUE SHIELD
NE10025584800Medicaid
NE275709Medicare PIN
NEU90272Medicare UPIN
NE10025584800Medicaid
NE110249687Medicaid
NENA1020Medicare PIN
NENA1020001Medicare PIN