Provider Demographics
NPI:1417082660
Name:ROBINSON, LISA L (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:409 W NEIDER AVE
Mailing Address - Street 2:STE C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9423
Mailing Address - Country:US
Mailing Address - Phone:208-765-5665
Mailing Address - Fax:208-765-1716
Practice Address - Street 1:409 W NEIDER AVE
Practice Address - Street 2:STE C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9423
Practice Address - Country:US
Practice Address - Phone:208-765-5665
Practice Address - Fax:208-765-1716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184854408Medicaid
ID1184854408Medicaid
IDU51318Medicare UPIN
ID15926322Medicare UPIN