Provider Demographics
NPI:1477561793
Name:NOBBE, RAYMOND TODD (OD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:TODD
Last Name:NOBBE
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 1:23 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-9101
Mailing Address - Country:US
Mailing Address - Phone:217-735-2020
Mailing Address - Fax:
Practice Address - Street 1:1400 WOODLAWN ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656
Practice Address - Country:US
Practice Address - Phone:217-735-2020
Practice Address - Fax:217-735-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU52138Medicare UPIN
IL5171810001Medicare NSC
IL200933Medicare ID - Type Unspecified
IL410047306Medicare ID - Type UnspecifiedRAILROAD