Provider Demographics
NPI:1619918240
Name:ROBINSON, JENNIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LYNN
Last Name:ROBINSON
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 1:333 17TH ST
Mailing Address - Street 2:STE G
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5672
Mailing Address - Country:US
Mailing Address - Phone:772-564-9512
Mailing Address - Fax:
Practice Address - Street 1:333 17TH ST
Practice Address - Street 2:STE G
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5672
Practice Address - Country:US
Practice Address - Phone:772-569-6600
Practice Address - Fax:772-569-5341
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU97822Medicare UPIN