Individual
DR. TODD A THEOBALD
Active
Individual
DR. TODD A THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0101237885
VA
207W00000X
Ophthalmology Physician
2009032081
MO
207W00000X
Ophthalmology Physician
74395
GA
207W00000X
Ophthalmology Physician
Primary
DR.0057386
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027564
KAISER COMMERCIAL NUMBER
CO
05
—
04155149
—
CO
01
—
431560263
TRICARE WEST
—
01
—
P00799494
RAILROAD MEDICARE
MO
Enumeration date
10/19/2005
Last updated
06/21/2021
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