Provider Demographics
NPI:1235176348
Name:ROBINSON, SHELBY D (OD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:D
Last Name:ROBINSON
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:PO BOX 111597
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1597
Mailing Address - Country:US
Mailing Address - Phone:253-531-5535
Mailing Address - Fax:253-531-5535
Practice Address - Street 1:1314 72ND ST E STE D
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3343
Practice Address - Country:US
Practice Address - Phone:253-531-5535
Practice Address - Fax:253-537-1657
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031839Medicaid
WA2031839Medicaid
WAG8860651Medicare PIN