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General NPI Number Information
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NPI Number | 1134294937
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Entity Type | Individual
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Provider Name | MARK DOUGLAS ROBERTSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2701 DAVID MCLEOD BLVD.
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City | FLORENCE
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State | SC
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Zip | 29501
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Country | US
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Telephone | 843-661-0924
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Fax | 843-661-0926
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Provider Business Mailing Address
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Address Line | 3560 W HAMPTON POINTE DR
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City | FLORENCE
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State | SC
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Zip | 29501-8646
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Country | US
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Telephone | 843-667-6352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 887
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License Number State | SC
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