Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3567T621 | OH |
NPI | 1003811837 |
---|---|
Provider Name | Mark K. Robinson |
First Address | Lockland, OH 45215-4624 |
Second Address | Lockland, OH 45215-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 12/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0547322 | (05) | OH |
T47851 | (02) | OH |