Healthcare Provider Details

I. General information

NPI: 1114990116
Provider Name (Legal Business Name): ROBERT L TOAL JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 NORTH MARKET SUITE A
WATERLOO IL
62298
US

IV. Provider business mailing address

742 NORTH MARKET SUITE A
WATERLOO IL
62298
US

V. Phone/Fax

Practice location:
  • Phone: 618-939-4040
  • Fax: 618-939-3903
Mailing address:
  • Phone: 618-939-4040
  • Fax: 618-939-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: