Provider Demographics
NPI:1326031477
Name:DRESCHER, ROBIN J (OD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:DRESCHER
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 1:795 E. SECOND STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-469-8773
Mailing Address - Fax:909-469-5228
Practice Address - Street 1:795 E SECOND STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3899
Practice Address - Fax:909-469-8640
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7888TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA797ZOtherMEDICARE PTAN SO CAL
TN2227OtherOD
TN3944590Medicare ID - Type Unspecified
TN0416100001Medicare NSC
U87026Medicare UPIN
TN3944590Medicaid