Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1499 | SC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2041 | SC |
NPI | 1083874036 |
---|---|
Provider Name | Dr. Jonathan M Robinson |
First Address | Rock Hill, SC 29732-3421 |
Second Address | Rock Hill, SC 29732-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 13/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014991 | (05) | SC |
APPLYING FOR | (05) | SC |