Provider Demographics
NPI:1104875079
Name:ROBERSON, REX M (OD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:M
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6043 S STEELE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3061
Mailing Address - Country:US
Mailing Address - Phone:303-795-6171
Mailing Address - Fax:
Practice Address - Street 1:200 W COUNTY LINE RD
Practice Address - Street 2:150
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2360
Practice Address - Country:US
Practice Address - Phone:303-794-2433
Practice Address - Fax:303-730-3019
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08123804Medicaid
CO08123804Medicaid
CO08123804Medicaid
MR0016065OtherDEA