Provider Demographics
NPI:1437101144
Name:ROBISON, SCOTT E (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:ROBISON
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 1:925 N 87TH ST
Mailing Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4812
Mailing Address - Country:US
Mailing Address - Phone:414-456-7934
Mailing Address - Fax:414-456-6300
Practice Address - Street 1:925 N 87TH ST
Practice Address - Street 2:MED COLLEGE CLINICS AT THE EYE INST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4812
Practice Address - Country:US
Practice Address - Phone:414-456-7934
Practice Address - Fax:414-456-6300
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437101144Medicaid
000018515XOtherHUMANA
000018515XOtherHUMANA
WI1437101144Medicaid