Healthcare Provider Details

I. General information

NPI: 1164455812
Provider Name (Legal Business Name): TIFFANY CORBY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HOLLISTER AVE
SANTA BARBARA CA
93111-2306
US

IV. Provider business mailing address

5300 HOLLISTER AVE
SANTA BARBARA CA
93111-2306
US

V. Phone/Fax

Practice location:
  • Phone: 805-692-6977
  • Fax: 805-692-6987
Mailing address:
  • Phone: 805-692-6977
  • Fax: 805-692-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number11870T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number11870T
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number11870T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: