Provider Demographics
NPI:1437514387
Name:TERRY P TOBIN OD PC
Entity Type:Organization
Organization Name:TERRY P TOBIN OD PC
Other - Org Name:CEDAR MILL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-314-7478
Mailing Address - Street 1:660 NW MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5872
Mailing Address - Country:US
Mailing Address - Phone:503-646-6166
Mailing Address - Fax:503-646-8113
Practice Address - Street 1:660 NW MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5872
Practice Address - Country:US
Practice Address - Phone:503-646-6166
Practice Address - Fax:503-646-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1567ATI261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty