Toby Palm, O.D.
Individual provider Active NPI Optometrist · Sutherlin, OR
NPI 1366430936 · NPPES record last updated Jul 17, 2015
Key facts
- NPI
- 1366430936
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2872T (OR)
- Practice address
- 201 Dakota Street
Sutherlin, OR 97479-9113 - Phone
- (541) 459-4333
- Fax
- (541) 459-7512
- NPI assigned
- Oct 7, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
201 Dakota St
Sutherlin, OR 97479-9908
Phone (541) 459-4333
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 57 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061016000593 | OR | Practitioner - Optometry | 3375443260 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2872T | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Toby J. Palm O.D., P.C. | Optometrist | Current |
Accepting new patients |
| Fort McDowell Yavapai Nation | Past | Accepting new patients |
Locations
201 Dakota St
Sutherlin, OR 97479
Phone (541) 459-4333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1327 | AZ | |
| Optometrist | 152W00000X | 2872T | OR | Yes |
Addresses
Primary practice location
201 Dakota Street
Sutherlin, OR 97479-9113
Mailing address
201 Dakota Street
Sutherlin, OR 97479-9113
Phone (541) 459-4333
Other providers in Sutherlin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.