Provider Demographics
NPI:1518029198
Name:ROBBINS, BRENT A (OD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:A
Last Name:ROBBINS
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 1:2000 LAKES EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8017
Mailing Address - Country:US
Mailing Address - Phone:812-853-9512
Mailing Address - Fax:
Practice Address - Street 1:6614 LOGAN DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8236
Practice Address - Country:US
Practice Address - Phone:812-477-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002483B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
636190Medicare ID - Type Unspecified