Provider Demographics
NPI:1881721587
Name:SOBOLEWSKI, THOMAS (RDO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SOBOLEWSKI
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1710
Mailing Address - Country:US
Mailing Address - Phone:508-755-0521
Mailing Address - Fax:
Practice Address - Street 1:383 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1710
Practice Address - Country:US
Practice Address - Phone:508-755-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4689156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician