Provider Demographics
NPI:1134197288
Name:ROBENSTINE, RICK L (OD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:L
Last Name:ROBENSTINE
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 1:1370 S SAWBURG AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5761
Mailing Address - Country:US
Mailing Address - Phone:330-821-5367
Mailing Address - Fax:330-821-1981
Practice Address - Street 1:1370 S SAWBURG AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5761
Practice Address - Country:US
Practice Address - Phone:330-821-5367
Practice Address - Fax:330-821-1981
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3508 T618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000312625OtherANTHEM
OH0714598Medicaid
OHT47255Medicare UPIN
OH000000312625OtherANTHEM