Provider Demographics
NPI:1144213182
Name:ROBINSON, JAMES WALLACE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27607 STATE ROAD 56
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8834
Mailing Address - Country:US
Mailing Address - Phone:813-406-4993
Mailing Address - Fax:813-406-4997
Practice Address - Street 1:27607 STATE ROAD 56
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8834
Practice Address - Country:US
Practice Address - Phone:813-406-4993
Practice Address - Fax:813-406-4997
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620575500Medicaid
FLU85581Medicare UPIN
FL20975ZMedicare ID - Type UnspecifiedOAF GROUP K0738
FL20975WMedicare PIN