Provider Demographics
NPI:1316978869
Name:JOBA, ROBERT JUDE (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JUDE
Last Name:JOBA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 ERIE ROAD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047
Mailing Address - Country:US
Mailing Address - Phone:716-947-2462
Mailing Address - Fax:716-947-2464
Practice Address - Street 1:6929 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047
Practice Address - Country:US
Practice Address - Phone:716-947-2462
Practice Address - Fax:716-947-2464
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247061Medicare ID - Type Unspecified
NYU45553Medicare UPIN