Provider Demographics
NPI:1174797807
Name:DAVID STEVE HOBBS
Entity type:Organization
Organization Name:DAVID STEVE HOBBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-226-5858
Mailing Address - Street 1:1203 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2835
Mailing Address - Country:US
Mailing Address - Phone:580-226-5858
Mailing Address - Fax:580-223-1476
Practice Address - Street 1:1203 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2835
Practice Address - Country:US
Practice Address - Phone:580-226-5858
Practice Address - Fax:580-223-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764850AMedicaid
OK100764850AMedicaid
OK446463158Medicare PIN
OKT10504Medicare UPIN
OK=========OtherTAX ID