Provider Demographics
NPI:1073678546
Name:ROBERTSON, FRANK (ABOC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARROLL PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-4601
Mailing Address - Country:US
Mailing Address - Phone:410-848-9243
Mailing Address - Fax:
Practice Address - Street 1:5 CARROLL PLZ
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-4601
Practice Address - Country:US
Practice Address - Phone:410-848-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40546OtherMAMSI,OPTIMUMCHOICE,MDIPA
MD813872OtherAETNA
MD210179OtherNVA
MDXY64Medicare ID - Type Unspecified