1215188255 NPI number — DR. LEE WILLIAM ROBERTSON O.D.

Table of content: DR. LEE WILLIAM ROBERTSON O.D. (NPI 1215188255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215188255 NPI number — DR. LEE WILLIAM ROBERTSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
LEE
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215188255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 W SPOTSWOOD TRAIL
Provider Second Line Business Mailing Address:
ELKTON EYECARE
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-298-1671
Provider Business Mailing Address Fax Number:
540-298-1464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 W SPOTSWOOD TRAIL
Provider Second Line Business Practice Location Address:
ELKTON EYECARE
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-298-1671
Provider Business Practice Location Address Fax Number:
540-298-1464
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  628 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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