Provider Demographics
NPI:1912118423
Name:ODENTZ, ROBIN SETH (REGISTERED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:SETH
Last Name:ODENTZ
Suffix:
Gender:M
Credentials:REGISTERED OPTICIAN
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:HELENE
Other - Last Name:ODENTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PARTNER
Mailing Address - Street 1:1964 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1055
Mailing Address - Country:US
Mailing Address - Phone:413-543-4520
Mailing Address - Fax:413-543-5444
Practice Address - Street 1:1964 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1055
Practice Address - Country:US
Practice Address - Phone:413-543-4520
Practice Address - Fax:413-543-5444
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1690156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist