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General NPI Number Information
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NPI Number | 1437514387
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Entity Type | Organization
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Legal Business Name | TERRY P TOBIN OD PC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 660 NW MURRAY BLVD
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City | PORTLAND
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State | OR
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Zip | 97229-5872
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Country | US
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Telephone | 503-646-6166
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Fax | 503-646-8113
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Provider Business Mailing Address
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Address Line | 660 NW MURRAY BLVD
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City | PORTLAND
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State | OR
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Zip | 97229-5872
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Country | US
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Telephone | 503-646-6166
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Fax | 503-646-8113
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY PATRICK TOBIN
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Credential | OD
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Telephone | 503-314-7478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1567ATI
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License Number State | OR
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