Healthcare Provider Details

I. General information

NPI: 1881691327
Provider Name (Legal Business Name): WARREN M SOBOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE STE 3200
CLEVELAND OH
44106
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35052646
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD417521
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30488
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35052646
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number30488
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD417521
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: