Individual
DR. TANIA NICOLE SOBCHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1990 MCCULLOCH BLVD N, # 101, LAKE HAVASU CITY, AZ 86403-5749
(928) 855-5026
(928) 854-4512
Mailing address
1990 MCCULLOCH BLVD N, SUITE 101, LAKE HAVASU CITY, AZ 86403-5749
(928) 855-5026
(928) 854-4512
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1311
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1311
STATE LICENSE NUMBER
AZ
05
—
806028
—
AZ
Enumeration date
02/23/2006
Last updated
03/07/2023
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