Provider Demographics
NPI:1609935139
Name:JACKMAN, ROBIN OMA (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:OMA
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S CAMINO DEL RIO STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-247-8762
Mailing Address - Fax:970-385-4496
Practice Address - Street 1:1165 S CAMINO DEL RIO STE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-247-8762
Practice Address - Fax:970-385-4496
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT10605Medicare UPIN
COCF6223Medicare PIN