Individual provider · NPI-1
Bobby Joe Tucker
Technician/Technologist, Optician · Parma Heights, OH
NPI number1750987079
StatusActive
Last updated in NPPESDec 10, 2020
Details
- NPI
- 1750987079
- Entity type
- Individual (NPI-1)
- Name
- Bobby Joe Tucker
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 10, 2020
- Certification date
- Dec 10, 2020
- Last updated
- Dec 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | OP.017156-S | OH | Yes |
| 332H00000X | Eyewear Supplier (Equipment, not the service) | – | – |
Practice location
6315 Pearl Rd Ste 206Parma Heights, OH 44130-3074
Phone 440-613-5222 · Fax 440-613-5222
Mailing address
712 Palmer AveYoungstown, OH 44502-2531
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.