Healthcare Provider Details

I. General information

NPI: 1922011980
Provider Name (Legal Business Name): SAMUEL R HOBBS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/22/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 VILLAGE WAY
TRENT WOODS NC
28562-7351
US

IV. Provider business mailing address

2805 VILLAGE WAY
TRENT WOODS NC
28562-7351
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-0016
  • Fax: 252-636-3895
Mailing address:
  • Phone: 252-633-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1905
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: