Provider Demographics
NPI:1972605921
Name:ROBINSON, DENNIS J (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 KIWANIS DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6921
Mailing Address - Country:US
Mailing Address - Phone:815-235-6177
Mailing Address - Fax:815-235-6180
Practice Address - Street 1:1000 KIWANIS DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6921
Practice Address - Country:US
Practice Address - Phone:815-235-6177
Practice Address - Fax:815-235-6180
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007308Medicaid
IL046007308Medicaid
ILT37574Medicare UPIN