Provider Demographics
NPI:1295894368
Name:ROBINSON, FANE LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:FANE
Middle Name:LAWRENCE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-609-7100
Mailing Address - Fax:858-609-7113
Practice Address - Street 1:7695 CARDINAL CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-609-7100
Practice Address - Fax:858-609-7113
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45990207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A459900Medicaid
C33015Medicare UPIN
CA00A459900Medicaid
CAWA45990GMedicare ID - Type Unspecified