MEDICARE: DR. SHARON M THEODORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	A91327	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831145739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON M THEODORE M.D.

Provider Business Mailing Address
First Line	:	300 JAMES WAY STE 150
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-876-3050
Fax Number	:	805-876-3052

Provider Business Practice Location Address
First Line	:	300 JAMES WAY STE 150
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2874
Country	:	US
Telephone Number	:	805-876-3050
Fax Number	:	805-876-3052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/16/2022

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