Provider Demographics
NPI:1194822064
Name:ROBBINS, STEWART DAVID (OD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:DAVID
Last Name:ROBBINS
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 1:107 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-5605
Mailing Address - Country:US
Mailing Address - Phone:325-365-5755
Mailing Address - Fax:325-365-5558
Practice Address - Street 1:107 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-5605
Practice Address - Country:US
Practice Address - Phone:325-365-5755
Practice Address - Fax:325-365-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6723TG152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176033201Medicaid
TX611886Medicare ID - Type Unspecified