Provider Demographics
NPI:1306111992
Name:HEATHER A ROBBEN OD LLC
Entity type:Organization
Organization Name:HEATHER A ROBBEN OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-259-3097
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-0458
Mailing Address - Country:US
Mailing Address - Phone:785-743-5522
Mailing Address - Fax:
Practice Address - Street 1:308 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-1802
Practice Address - Country:US
Practice Address - Phone:785-743-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200402860AMedicaid
KS6152030001OtherMEDICARE DME
KS651156OtherBLUE CROSS BLUE SHIELD
KSP00436065OtherMEDICARE RAILROAD
KS651156OtherBLUE CROSS BLUE SHIELD
KSV10690Medicare UPIN