Provider Demographics
NPI:1598842262
Name:ROBESON FAMILY VISION CENTER
Entity Type:Organization
Organization Name:ROBESON FAMILY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-454-4092
Mailing Address - Street 1:1350 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5017
Mailing Address - Country:US
Mailing Address - Phone:507-454-4092
Mailing Address - Fax:
Practice Address - Street 1:1350 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5017
Practice Address - Country:US
Practice Address - Phone:507-454-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2057332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0499750001Medicare NSC