Provider Demographics
NPI:1952378770
Name:VANCE-ISHAK, ROBIN LYNN (O D)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:VANCE-ISHAK
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:951F BEARDS HILL RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1734
Practice Address - Country:US
Practice Address - Phone:410-272-1800
Practice Address - Fax:410-272-5873
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0295152W00000X
NH0732152W00000X
MDTA0961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02936Medicare UPIN
231360YN2CMedicare PIN
231360YN2DMedicare PIN
U02936Medicare UPIN