Provider Demographics
NPI:1609021955
Name:TOBACK, MICHAEL H (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:TOBACK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6450
Mailing Address - Country:US
Mailing Address - Phone:212-228-2192
Mailing Address - Fax:212-228-1228
Practice Address - Street 1:57 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6450
Practice Address - Country:US
Practice Address - Phone:212-228-2192
Practice Address - Fax:212-228-1228
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4339-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician