Healthcare Provider Details

I. General information

NPI: 1063477990
Provider Name (Legal Business Name): TALITHA ROBINSON D'ITALIA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TALITHA GAY ROBINSON

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LIMESTONE RD SUITE 102
WILMINGTON DE
19808-2147
US

IV. Provider business mailing address

3105 LIMESTONE RD SUITE 102
WILMINGTON DE
19808-2147
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-1395
  • Fax: 302-998-6784
Mailing address:
  • Phone: 302-998-1395
  • Fax: 302-998-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000728
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI3-0001329
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberI3-0001329
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: