Provider Demographics
NPI:1407887854
Name:COLLARD, ROBIN THERESA (OD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:THERESA
Last Name:COLLARD
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 1:82 FELDMAN CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2818
Mailing Address - Country:US
Mailing Address - Phone:201-236-0893
Mailing Address - Fax:
Practice Address - Street 1:82 FELDMAN CT
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2818
Practice Address - Country:US
Practice Address - Phone:201-236-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00600800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0103926Medicaid