Basic Information
| Provider Information | |||||||||
| NPI: | 1639177165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBBINS | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 549 | ||||||||
| Address2: | |||||||||
| City: | WABASH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469920549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2605699550 | ||||||||
| FaxNumber: | 2605699244 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 W BOGGSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461769706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173989793 | ||||||||
| FaxNumber: | 3173923444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18001544A | IN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 3989793 | 01 | IN | METLIFE | OTHER | P01691122 | 01 | IN | RAILROAD MEDICRE | OTHER | 351381529 | 01 | IN | TRIWEST HEALTHCARE ALLIAN | OTHER | P01691122 | 01 | IN | RAILROAD MEDICARE | OTHER | 5426545 | 01 | IN | CCN | OTHER | 000000079075 | 01 | IN | ANTHEM | OTHER | 135012 | 01 | IN | COLE MANAGED VISION | OTHER | 4524990 | 01 | IN | AETNA | OTHER | 10012 | 01 | IN | HEALTHSOURCE | OTHER | 100150100A | 05 | IN | MEDICAID |