Provider Demographics
NPI:1245234160
Name:LOBBY, PAUL J (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LOBBY
Suffix:
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 1:159 BUTLER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2328
Mailing Address - Country:US
Mailing Address - Phone:724-545-6688
Mailing Address - Fax:724-545-6630
Practice Address - Street 1:159 BUTLER RD
Practice Address - Street 2:STE 2
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2328
Practice Address - Country:US
Practice Address - Phone:724-545-6688
Practice Address - Fax:724-545-6630
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-09-28
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAOEG000755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019616810001Medicaid
PA0019616810001Medicaid
PA4696280001Medicare NSC
PA064720Medicare PIN