Provider Demographics
NPI:1831304971
Name:SALLEY, ROBIN ASHLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ASHLEY
Last Name:SALLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2015 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6726
Mailing Address - Country:US
Mailing Address - Phone:719-475-2200
Mailing Address - Fax:719-578-5582
Practice Address - Street 1:3201 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6408
Practice Address - Country:US
Practice Address - Phone:719-578-0398
Practice Address - Fax:719-578-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist