Provider Demographics
NPI:1609003789
Name:ROBISON, ROSAMARIA PICCOLO (LO)
Entity Type:Individual
Prefix:
First Name:ROSAMARIA
Middle Name:PICCOLO
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 COLLINDALE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8319
Mailing Address - Country:US
Mailing Address - Phone:203-631-8660
Mailing Address - Fax:
Practice Address - Street 1:844 N COLONY RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2410
Practice Address - Country:US
Practice Address - Phone:203-265-5627
Practice Address - Fax:203-269-7712
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLO1290156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician