Provider Demographics
NPI:1699872036
Name:ROBINSON, MARK STEPHEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:ROBINSON
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:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-0672
Mailing Address - Country:US
Mailing Address - Phone:870-265-2274
Mailing Address - Fax:870-265-2325
Practice Address - Street 1:1655 HWY 65 SOUTH
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653
Practice Address - Country:US
Practice Address - Phone:870-265-2274
Practice Address - Fax:870-265-2325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133805722Medicaid
AR0298400001Medicare NSC
ART20208Medicare UPIN
AR48557Medicare PIN