MEDICARE: MR. THEODORE HORVAT SOBER OD

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	152W00000X	Optometrist	TA0612	MD

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	:	1972560282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE HORVAT SOBER OD

Provider Business Mailing Address
First Line	:	405 STEMMERS RUN RD
Second Line	:
City	:	ESSEX
State	:	MD
Zip	:	21221-3332
Country	:	US
Telephone Number	:	410-682-2888
Fax Number	:	410-682-9936

Provider Business Practice Location Address
First Line	:	405 STEMMERS RUN RD
Second Line	:
City	:	ESSEX
State	:	MD
Zip	:	21221-3332
Country	:	US
Telephone Number	:	410-682-2888
Fax Number	:	410-682-9936

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	06/25/2009

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