Provider Demographics
NPI:1487703807
Name:TOMSIK, ROBERTA LEE (OD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LEE
Last Name:TOMSIK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2091 FLORENCE BOULEVARD
Mailing Address - Street 2:PO BOX 159
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-766-2120
Mailing Address - Fax:256-766-2796
Practice Address - Street 1:2091 FLORENCE BOULEVARD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-766-2120
Practice Address - Fax:256-766-2796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS719TA177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51591340OtherBLUE CROSS OF AL
AL51591340OtherBLUE CROSS OF AL
AL510I410070Medicare PIN