Healthcare Provider Details

I. General information

NPI: 1366721318
Provider Name (Legal Business Name): TIMOTHY HOBBS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 LONE OAK ROAD
PADUCAH KY
42003
US

IV. Provider business mailing address

1130 LONE OAK ROAD
PADUCAH KY
42003-4540
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-0245
  • Fax: 270-415-0248
Mailing address:
  • Phone: 270-415-0245
  • Fax: 270-415-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1855DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: