NPIMap

Organization Active NPI

Lake Havasu Family Eyecare, LLC

  • Optometrist
  • Lake Havasu City, AZ
National Provider Identifier
1457569121
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1311 Issued in AZ
Legal business name
LAKE HAVASU FAMILY EYECARE, LLC
Practice address
2277 Swanson Ave Ste 100
Lake Havasu City, AZ 86403-5991
Phone
(928) 855-5026
Fax
(928) 854-4512
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tania Nicole Sobchuk, O.D.NPI 1760458384
Title
Owner
Phone
(928) 855-5026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1311 AZ Primary

Addresses

Primary practice location

2277 Swanson Ave Ste 100
Lake Havasu City, AZ 86403-5991

Mailing address

2277 Swanson Ave Ste 100
Lake Havasu City, AZ 86403-5991
Phone (928) 855-5026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050505000971 AZ Part B Supplier - Clinic/Group Practice 0749220051 Receives reassigned benefits from 12 practitioners
Practice locations: Lake Havasu City, AZ; Tucson, AZ; Sierra Vista, AZ
O20100930024750 AZ DME Supplier - Physician - OptometristDME Supplier - Optician 0749220051 Practice locations: Lake Havasu City, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Lake Havasu Family Eyecare2277 Swanson Ave, Lake Havasu City, AZ 86403-6141(928) 855-5026 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Apr 4, 2005

National Provider Directory

National Provider Directory

Locations

2277 Swanson Ave
Ste A
Lake Havasu City, AZ 86403

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1457569121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2277 SWANSON AVE STE 100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035991",
            "telephone_number": "928-855-5026",
            "fax_number": "928-854-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 SWANSON AVE STE 100",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035991",
            "telephone_number": "928-855-5026",
            "fax_number": "928-854-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HAVASU FAMILY EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "SOBCHUK",
        "authorized_official_first_name": "TANIA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-855-5026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.