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General NPI Number Information
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NPI Number | 1740458744
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Entity Type | Organization
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Legal Business Name | DR.MARK D.ROBERTSON,OD
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 2701 DAVID MCLEOD BOULEVARD C/O LENSCRAFTERS
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City | FLORENCE
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State | SC
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Zip | 29501-4028
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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 | 2701 DAVID MCLEOD BLVD C/O LENSCRAFTERS
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City | FLORENCE
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State | SC
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Zip | 29501-4028
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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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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK D ROBERTSON
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Credential | OD
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Telephone | 843-661-0924
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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 | SC08874
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License Number State | SC
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