Basic Information
| Provider Information | |||||||||
| NPI: | 1518029198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBBINS | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 LAKES EDGE DR | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128539512 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6614 LOGAN DR | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477158236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18002483B | IN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.