Provider Demographics
NPI:1619974722
Name:GOBER, THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GOBER
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:PO BOX 207170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7170
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:325 E LEWIS AND CLARK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1725
Practice Address - Country:US
Practice Address - Phone:812-288-2029
Practice Address - Fax:502-736-4490
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1530DT152W00000X
IN18002107A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100100740Medicaid
IN5375220001Medicare NSC
IN226010DMedicare PIN
INT34770Medicare UPIN
KY5375220004Medicare NSC
IN100100740Medicaid