Provider Demographics
NPI:1174517098
Name:ANDREASEN, TOBY LLOYD (OD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:LLOYD
Last Name:ANDREASEN
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 1:5317 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6447
Mailing Address - Country:US
Mailing Address - Phone:503-648-5522
Mailing Address - Fax:503-844-9334
Practice Address - Street 1:5317 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6447
Practice Address - Country:US
Practice Address - Phone:503-648-5522
Practice Address - Fax:503-844-9334
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2992ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD389ORMedicaid
OR240391Medicaid
AKOD389ORMedicaid
0629270001Medicare NSC
OR240391Medicaid