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General NPI Number Information
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NPI Number | 1275207839
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Entity Type | Individual
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Provider Name | CUBDEERIX ROBINSON OD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1689 NONCONNAH BLVD STE 120
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City | MEMPHIS
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State | TN
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Zip | 38132-2111
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Country | US
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Telephone | 901-271-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 503 W SECOND ST
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City | YAZOO CITY
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State | MS
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Zip | 39194-3474
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Country | US
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Telephone | 662-590-5181
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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 | 0618003291
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1041
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA3038
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OET009166
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License Number State | PA
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