Provider Demographics
NPI:1346406717
Name:SCOGGIN, ROBIN L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:SCOGGIN
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 1:203 GLEN MILNER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3239
Mailing Address - Country:US
Mailing Address - Phone:706-378-3000
Mailing Address - Fax:706-378-3087
Practice Address - Street 1:203 GLEN MILNER BLVD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3239
Practice Address - Country:US
Practice Address - Phone:706-378-3000
Practice Address - Fax:706-378-3087
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT90932Medicare UPIN