Provider Demographics
NPI:1790919256
Name:MARK ROBINSON OD
Entity Type:Organization
Organization Name:MARK ROBINSON OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-761-1363
Mailing Address - Street 1:123 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LOCKLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4624
Mailing Address - Country:US
Mailing Address - Phone:513-761-1363
Mailing Address - Fax:
Practice Address - Street 1:123 MILL ST
Practice Address - Street 2:
Practice Address - City:LOCKLAND
Practice Address - State:OH
Practice Address - Zip Code:45215-4624
Practice Address - Country:US
Practice Address - Phone:513-761-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3567T621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0208970001Medicare NSC