Provider Demographics
NPI:1083874036
Name:ROBINSON, JONATHAN M (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 EBENEZER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3421
Mailing Address - Country:US
Mailing Address - Phone:803-328-0168
Mailing Address - Fax:803-325-8473
Practice Address - Street 1:1565 EBENEZER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3421
Practice Address - Country:US
Practice Address - Phone:803-328-0168
Practice Address - Fax:803-325-8473
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2041152WC0802X
SC1499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPLYING FORMedicaid
SC014991Medicaid
SC2041Medicare PIN