Provider Demographics
NPI:1386702231
Name:TOBIN, TERRY PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:PATRICK
Last Name:TOBIN
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 1:660 NW MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5872
Mailing Address - Country:US
Mailing Address - Phone:503-646-6166
Mailing Address - Fax:
Practice Address - Street 1:660 NW MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5872
Practice Address - Country:US
Practice Address - Phone:503-646-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1567ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229997Medicaid
OR229997Medicaid
ORR0000PHDJLMedicare ID - Type Unspecified