Provider Demographics
NPI:1407969322
Name:TOBY J. PALM O.D., P.C.
Entity Type:Organization
Organization Name:TOBY J. PALM O.D., P.C.
Other - Org Name:PALM FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-459-4333
Mailing Address - Street 1:145 MYRTLE ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9113
Mailing Address - Country:US
Mailing Address - Phone:541-459-4333
Mailing Address - Fax:541-459-7512
Practice Address - Street 1:145 MYRTLE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9113
Practice Address - Country:US
Practice Address - Phone:541-459-4333
Practice Address - Fax:541-459-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2872T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty