Provider Demographics
NPI:1417082660
Name:ROBINSON, LISA L (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:131 COTTAGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-1317
Mailing Address - Country:US
Mailing Address - Phone:509-888-5877
Mailing Address - Fax:
Practice Address - Street 1:131 COTTAGE AVE STE A
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1317
Practice Address - Country:US
Practice Address - Phone:509-888-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184854408Medicaid
ID1184854408Medicaid
IDU51318Medicare UPIN
ID15926322Medicare UPIN