Provider Demographics
NPI:1003811837
Name:ROBINSON, MARK K (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:K
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 1:123 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LOCKLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4624
Mailing Address - Country:US
Mailing Address - Phone:513-761-1363
Mailing Address - Fax:513-761-1364
Practice Address - Street 1:123 MILL ST
Practice Address - Street 2:
Practice Address - City:LOCKLAND
Practice Address - State:OH
Practice Address - Zip Code:45215-4624
Practice Address - Country:US
Practice Address - Phone:513-761-1363
Practice Address - Fax:513-761-1364
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3567T621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547322Medicaid
OHT47851Medicare UPIN
OH0547322Medicaid