Provider Demographics
NPI:1184854408
Name:LISA L ROBINSON OD PC
Entity Type:Organization
Organization Name:LISA L ROBINSON OD PC
Other - Org Name:COEUR D ALENE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:208-765-5665
Mailing Address - Street 1:409 W NEIDER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9423
Mailing Address - Country:US
Mailing Address - Phone:208-765-5665
Mailing Address - Fax:208-765-1716
Practice Address - Street 1:409 W NEIDER AVE STE C
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9423
Practice Address - Country:US
Practice Address - Phone:208-765-5665
Practice Address - Fax:208-765-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184854408Medicaid
IDU51318Medicare UPIN
ID1184854408Medicaid
ID15926322Medicare PIN