Provider Demographics
NPI:1659327054
Name:R J JOBA OD PC
Entity Type:Organization
Organization Name:R J JOBA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:JOBA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-947-2462
Mailing Address - Street 1:6929 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9406
Mailing Address - Country:US
Mailing Address - Phone:716-947-2462
Mailing Address - Fax:716-947-2464
Practice Address - Street 1:6929 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9406
Practice Address - Country:US
Practice Address - Phone:716-947-2462
Practice Address - Fax:716-947-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005442-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization