Provider Demographics
NPI:1831403773
Name:ROBERTSON, ARIC DAVID (OD)
Entity type:Individual
Prefix:MR
First Name:ARIC
Middle Name:DAVID
Last Name:ROBERTSON
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 1:5318 S CASCADE PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4549
Mailing Address - Country:US
Mailing Address - Phone:231-855-2132
Mailing Address - Fax:
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7689
Practice Address - Country:US
Practice Address - Phone:509-735-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60167669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist