Healthcare Provider Details

I. General information

NPI: 1992774863
Provider Name (Legal Business Name): TOBIN OPTICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VILLAGE DR
SAINT JOSEPH MO
64506-2459
US

IV. Provider business mailing address

1407 VILLAGE DR
SAINT JOSEPH MO
64506-2459
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-1363
  • Fax: 816-233-8936
Mailing address:
  • Phone: 816-279-1363
  • Fax: 816-233-8936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number00480119
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT F TOBIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 816-279-1363