Provider Demographics
NPI:1225749625
Name:TODD WOLLBRINCK, OD, PC
Entity Type:Organization
Organization Name:TODD WOLLBRINCK, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLLBRINCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-853-6016
Mailing Address - Street 1:601 WOOD THRUSH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2170
Mailing Address - Country:US
Mailing Address - Phone:314-853-6016
Mailing Address - Fax:
Practice Address - Street 1:400 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-4323
Practice Address - Country:US
Practice Address - Phone:618-659-1870
Practice Address - Fax:618-659-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty