MEDICARE: MARK ROBINSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3567T621	OH

General Provider Information

NPI Number	:	1790919256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK ROBINSON OD

Provider Business Mailing Address
First Line	:	123 MILL ST
Second Line	:
City	:	LOCKLAND
State	:	OH
Zip	:	45215-4624
Country	:	US
Telephone Number	:	513-761-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 MILL ST
Second Line	:
City	:	LOCKLAND
State	:	OH
Zip	:	45215-4624
Country	:	US
Telephone Number	:	513-761-1363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK K ROBINSON
Credential	:
Telephone Number	:	513-761-1363

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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