Provider Demographics
NPI:1407082837
Name:ROBESON FAMILY VISION CENTER INC
Entity Type:Organization
Organization Name:ROBESON FAMILY VISION CENTER INC
Other - Org Name:ROBESON FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-454-4092
Mailing Address - Street 1:1400 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6044
Mailing Address - Country:US
Mailing Address - Phone:507-454-4092
Mailing Address - Fax:507-454-5384
Practice Address - Street 1:1400 HOMER RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6044
Practice Address - Country:US
Practice Address - Phone:507-454-4092
Practice Address - Fax:507-454-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6286790001Medicare NSC