Provider Demographics
NPI:1164462776
Name:ROBINSON, BRIAN KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
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 1:1210 MINERAL WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4914
Mailing Address - Country:US
Mailing Address - Phone:731-986-4400
Mailing Address - Fax:731-986-7981
Practice Address - Street 1:400 HWY 51 BYPASS
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-286-2744
Practice Address - Fax:731-285-3235
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3599533Medicaid
TN4105814OtherBLUE CROSS BLUE SHIELD
TN6205OtherTLC MEMPHIS MANAGED CARE
9019808OtherCIGNA HEALTHCARE
TN3599533Medicare PIN
9019808OtherCIGNA HEALTHCARE
U53197Medicare UPIN