Provider Demographics
NPI:1437138484
Name:ROBERTSON, RODNEY LEE (OD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:LEE
Last Name:ROBERTSON
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 1:1220 N TOWN EAST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7605
Mailing Address - Country:US
Mailing Address - Phone:972-613-9000
Mailing Address - Fax:972-613-0175
Practice Address - Street 1:1220 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7605
Practice Address - Country:US
Practice Address - Phone:972-613-9000
Practice Address - Fax:972-613-0175
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3735TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15588Medicare UPIN
8342B9Medicare PIN