Provider Demographics
NPI:1942331723
Name:ROY, ROBIN LARSON (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LARSON
Last Name:ROY
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 1:1160 AUBURN AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113
Mailing Address - Country:US
Mailing Address - Phone:216-298-9092
Mailing Address - Fax:
Practice Address - Street 1:4474 EVERHARD RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2418
Practice Address - Country:US
Practice Address - Phone:330-494-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2949152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO0682965Medicare ID - Type Unspecified