Provider Demographics
NPI:1487641080
Name:ROBISON, DANIEL ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALLEN
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 1:17777 LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5398
Mailing Address - Country:US
Mailing Address - Phone:503-635-8819
Mailing Address - Fax:503-635-1512
Practice Address - Street 1:17777 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5398
Practice Address - Country:US
Practice Address - Phone:503-635-8819
Practice Address - Fax:503-635-1512
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2371AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138813Medicaid
ORR162208Medicare PIN
ORU45460Medicare UPIN
OR0638890001Medicare NSC