Provider Demographics
NPI:1649832304
Name:ROBOCA-VU, MARYBETH
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:ROBOCA-VU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:ROBOCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 NW 12TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 NW 12TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9145
Practice Address - Country:US
Practice Address - Phone:360-687-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60969191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist