Provider Demographics
NPI:1609752922
Name:ROBERTSON, BILLIE (TECH)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6741
Mailing Address - Country:US
Mailing Address - Phone:405-902-6690
Mailing Address - Fax:405-902-6690
Practice Address - Street 1:1209 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6741
Practice Address - Country:US
Practice Address - Phone:405-902-6690
Practice Address - Fax:405-902-6690
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty