Healthcare Provider Details

I. General information

NPI: 1427048305
Provider Name (Legal Business Name): EDWIN H. ROBISON III O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 HWY 528
BERNALILLO NM
87004-6633
US

IV. Provider business mailing address

460 HWY 528
BERNALILLO NM
87004-6633
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-4883
  • Fax: 505-771-4885
Mailing address:
  • Phone: 505-771-4883
  • Fax: 505-771-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number244
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: