Provider Demographics
NPI:1730195579
Name:ROBINSON, SUSAN L (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 HIGH ST
Mailing Address - Street 2:STE 101/102
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4158
Mailing Address - Country:US
Mailing Address - Phone:614-888-5058
Mailing Address - Fax:614-888-0679
Practice Address - Street 1:885 HIGH ST
Practice Address - Street 2:STE 101/102
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4158
Practice Address - Country:US
Practice Address - Phone:614-888-5058
Practice Address - Fax:614-888-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90977Medicare UPIN
4087411Medicare ID - Type UnspecifiedPROVIDER