Provider Demographics
NPI:1326044835
Name:ROBINSON, PHILIP A (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
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 1:127 FOOTHILLS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1090
Mailing Address - Country:US
Mailing Address - Phone:606-387-5612
Mailing Address - Fax:606-387-6602
Practice Address - Street 1:3810 S HIGHWAY 27
Practice Address - Street 2:SUITE 1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3073
Practice Address - Country:US
Practice Address - Phone:606-678-4551
Practice Address - Fax:606-678-0972
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1490DT152W00000X
TN2191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000198Medicaid
TN3944114Medicaid
KY0489770006Medicare NSC
KY7100209960Medicaid
KY0880901Medicare PIN
01257725OtherAMERIGROUP
KYU81897Medicare UPIN
KY0241607Medicare PIN
TN4044482OtherTENNCARE/BLUECARE/BCBSTN
TN3944114Medicare PIN