1336118140 NPI number — TOBIN EYE CLINIC, INC

Table of content: (NPI 1336118140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336118140 NPI number — TOBIN EYE CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOBIN EYE CLINIC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336118140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-279-1363
Provider Business Mailing Address Fax Number:
816-233-8936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68107-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-731-1363
Provider Business Practice Location Address Fax Number:
402-731-3292
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOBIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
402-731-1363

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  ASC026 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2947192 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0968529 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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