Provider Demographics
NPI:1629564554
Name:MORRISON, ROBIN BENNETT (LDO)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:BENNETT
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-4708
Mailing Address - Country:US
Mailing Address - Phone:239-340-8267
Mailing Address - Fax:239-693-6564
Practice Address - Street 1:13468 PALM BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2168
Practice Address - Country:US
Practice Address - Phone:239-887-6187
Practice Address - Fax:239-693-6564
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2216156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician