Provider Demographics
NPI:1215443775
Name:TOBIAS, SAMANTHA JOANNE (LDO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOANNE
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 COUNTY ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2297
Mailing Address - Country:US
Mailing Address - Phone:607-739-5209
Mailing Address - Fax:607-739-5370
Practice Address - Street 1:1400 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2297
Practice Address - Country:US
Practice Address - Phone:607-739-5209
Practice Address - Fax:607-739-5370
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY008056-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician