Provider Demographics
NPI:1902031529
Name:ROBINSON LAW, CANDICE A (OD)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:A
Last Name:ROBINSON LAW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:A
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7701 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1635
Mailing Address - Country:US
Mailing Address - Phone:816-444-2900
Mailing Address - Fax:816-444-3341
Practice Address - Street 1:BROOKSIDE EYE CARE CENTER
Practice Address - Street 2:520 E 63RD STREET
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110
Practice Address - Country:US
Practice Address - Phone:816-333-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist