Provider Demographics
NPI:1528376589
Name:ROBBEN, JERRY LEE
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:ROBBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 BONNEVAL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7565
Mailing Address - Country:US
Mailing Address - Phone:904-296-0098
Mailing Address - Fax:904-861-3899
Practice Address - Street 1:12341 YELLOW BLUFF RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2025
Practice Address - Country:US
Practice Address - Phone:904-696-9486
Practice Address - Fax:904-696-3422
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist