Provider Demographics
NPI:1134540891
Name:ROBINSON, CHARITY KARILYN (OD)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:KARILYN
Last Name:ROBINSON
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 1:8777 N OLD STATE ROAD 37
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9246
Mailing Address - Country:US
Mailing Address - Phone:812-727-0534
Mailing Address - Fax:812-727-3452
Practice Address - Street 1:2251 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9498
Practice Address - Country:US
Practice Address - Phone:812-847-7880
Practice Address - Fax:812-847-8104
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201398970Medicaid