Provider Demographics
NPI:1780671917
Name:ROBINSON, MARK D (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:827 FAIRMONT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3857
Mailing Address - Country:US
Mailing Address - Phone:304-296-3333
Mailing Address - Fax:304-296-2220
Practice Address - Street 1:827 FAIRMONT RD
Practice Address - Street 2:STE 105
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3857
Practice Address - Country:US
Practice Address - Phone:304-296-3333
Practice Address - Fax:304-296-2220
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV663-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150683000Medicaid
WVT32606Medicare UPIN
WV0532207Medicare PIN
WV5439530001Medicare NSC