Provider Demographics
NPI:1114990116
Name:TOAL, ROBERT L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:TOAL
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:742 NORTH MARKET
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298
Mailing Address - Country:US
Mailing Address - Phone:618-939-4040
Mailing Address - Fax:618-939-3903
Practice Address - Street 1:742 NORTH MARKET
Practice Address - Street 2:SUITE A
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298
Practice Address - Country:US
Practice Address - Phone:618-939-4040
Practice Address - Fax:618-939-3903
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06369Medicare UPIN
ILK12610Medicare PIN