Provider Demographics
NPI:1043223423
Name:ROBINSON, FRANK JR (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 OLD TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2639
Mailing Address - Country:US
Mailing Address - Phone:260-203-5905
Mailing Address - Fax:260-218-1802
Practice Address - Street 1:6710 OLD TRAIL RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-2639
Practice Address - Country:US
Practice Address - Phone:260-203-5905
Practice Address - Fax:260-218-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100257880 HMedicaid
IN100257880 HMedicaid