Provider Demographics
NPI:1790710101
Name:HOBBS, DAVID STEVE (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STEVE
Last Name:HOBBS
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 1:1203 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2835
Mailing Address - Country:US
Mailing Address - Phone:580-226-5858
Mailing Address - Fax:580-223-1476
Practice Address - Street 1:1203 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2818
Practice Address - Country:US
Practice Address - Phone:580-226-5858
Practice Address - Fax:580-223-1476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764850AMedicaid
OK731021922OtherTAX ID
OK100764850AMedicaid
$$$$$$$$$-001OtherBCBS
$$$$$$$$$Medicare PIN
OK731021922OtherTAX ID