Basic Information
| Provider Information | |||||||||
| NPI: | 1487206611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINS | ||||||||
| FirstName: | MARNI | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1322 JAMESTOWN RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231853321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572298660 | ||||||||
| FaxNumber: | 7572588845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 W GODFREY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152766000 | ||||||||
| FaxNumber: | 2152761329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2019 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0603000456 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.