Provider Demographics
NPI:1992867816
Name:TOBIN OPTICAL CENTER
Entity Type:Organization
Organization Name:TOBIN OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:816-279-1363
Mailing Address - Street 1:1407 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2459
Mailing Address - Country:US
Mailing Address - Phone:816-279-1363
Mailing Address - Fax:816-233-8936
Practice Address - Street 1:4151 E ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1129
Practice Address - Country:US
Practice Address - Phone:402-245-2616
Practice Address - Fax:402-245-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8390142332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========08Medicaid
NE1309590003Medicare NSC