Healthcare Provider Details

I. General information

NPI: 1497669766
Provider Name (Legal Business Name): SAMUEL A ROBINSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

IV. Provider business mailing address

63 BITTERSWEET LN
MORRISONVILLE NY
12962-9725
US

V. Phone/Fax

Practice location:
  • Phone: 218-335-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4090
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: