Provider Demographics
NPI:1013910975
Name:SMITH-TROTTER, ROBIN LYNN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:SMITH-TROTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2831
Mailing Address - Country:US
Mailing Address - Phone:580-225-1555
Mailing Address - Fax:580-225-1558
Practice Address - Street 1:1020 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2831
Practice Address - Country:US
Practice Address - Phone:580-225-1555
Practice Address - Fax:580-225-1558
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2051613OtherUNITED HEALTHCARE
OK7915200OtherAETNA
OK100759860AMedicaid
OK410039952Medicare PIN
OKU57620Medicare UPIN
OK$$$$$$$$$RMedicare PIN