Provider Demographics
NPI:1164769808
Name:JEFFREY B. ROBIN, MD PA
Entity Type:Organization
Organization Name:JEFFREY B. ROBIN, MD PA
Other - Org Name:ROBIN VISION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:ROBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-587-5137
Mailing Address - Street 1:4044 W LAKE MARY BLVD
Mailing Address - Street 2:UNIT 104, #125
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2012
Mailing Address - Country:US
Mailing Address - Phone:407-587-5137
Mailing Address - Fax:866-205-5839
Practice Address - Street 1:1455 W HOLDEN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1702
Practice Address - Country:US
Practice Address - Phone:407-545-3588
Practice Address - Fax:866-205-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGY450AMedicare PIN