Provider Demographics
NPI:1154393023
Name:JEWELL, ROBIN A (OD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:A
Last Name:JEWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:A
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:70 PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1747
Mailing Address - Country:US
Mailing Address - Phone:508-476-3710
Mailing Address - Fax:508-476-1750
Practice Address - Street 1:601 DONALD LYNCH BLVD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4730
Practice Address - Country:US
Practice Address - Phone:508-481-8279
Practice Address - Fax:508-303-0845
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369691Medicaid
MAJEW17034Medicare ID - Type Unspecified
MA0369691Medicaid