Provider Demographics
NPI:1710186887
Name:BAUTISTA, ROBIN ECO (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ECO
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 DARLENE LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1601
Mailing Address - Country:US
Mailing Address - Phone:541-343-5000
Mailing Address - Fax:541-344-9476
Practice Address - Street 1:1125 DARLENE LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1601
Practice Address - Country:US
Practice Address - Phone:541-343-5000
Practice Address - Fax:541-344-9478
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3260ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist