Provider Demographics
NPI:1851397244
Name:ROBINSON, ROXANN L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROXANN
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2160
Mailing Address - Country:US
Mailing Address - Phone:804-595-1244
Mailing Address - Fax:804-595-1260
Practice Address - Street 1:6019 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2160
Practice Address - Country:US
Practice Address - Phone:804-595-1244
Practice Address - Fax:804-595-1260
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010156262Medicaid
VA00W357R01Medicare PIN
VAT21794Medicare UPIN