Provider Demographics
NPI:1346277126
Name:BOBST, THOMAS MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:BOBST
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 1:23609 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2222
Mailing Address - Country:US
Mailing Address - Phone:440-734-9920
Mailing Address - Fax:440-734-2870
Practice Address - Street 1:23609 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2222
Practice Address - Country:US
Practice Address - Phone:440-734-9920
Practice Address - Fax:440-734-2870
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651/T364152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0507062Medicaid
OH0883480001OtherMEDICARE DME
OH0883480001OtherMEDICARE DME
OHT48345Medicare UPIN