Healthcare Provider Details

I. General information

NPI: 1407082837
Provider Name (Legal Business Name): ROBESON FAMILY VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOMER RD
WINONA MN
55987-6044
US

IV. Provider business mailing address

1400 HOMER RD
WINONA MN
55987-6044
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-4092
  • Fax: 507-454-5384
Mailing address:
  • Phone: 507-454-4092
  • Fax: 507-454-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. LANE C ROBESON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 507-454-4092