Individual provider Active NPI

Tania Nicole Sobchuk, O.D.

  • Optometrist
  • Lake Havasu City, AZ
National Provider Identifier
1760458384
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1311 Issued in AZ
Practice address
1990 McCulloch Blvd N
# 101
Lake Havasu City, AZ 86403-5749
Phone
(928) 855-5026
Fax
(928) 854-4512
NPI assigned
Feb 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1311 AZ Primary

Addresses

Primary practice location

1990 McCulloch Blvd N
# 101
Lake Havasu City, AZ 86403-5749

Mailing address

1990 McCulloch Blvd N
Suite 101
Lake Havasu City, AZ 86403-5749
Phone (928) 855-5026

Other identifiers 2

IdentifierTypeStateIssuer
1311OtherAZSTATE LICENSE NUMBER
806028MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050516000020 AZ Practitioner - Optometry 9638119944 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.83 of 100Reported as group
Quality
65.65
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1311AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Havasu Family Eyecare, LLC Optometrist CurrentSince Apr 1, 2005 Accepting new patients
James a Tammaro MD PC Optometrist Past Accepting new patients

Locations

1990 McCulloch Blvd N
Ste 101
Lake Havasu City, AZ 86403
Phone (702) 242-5555

2277 Swanson Ave
Ste 100
Lk Havasu Cty, AZ 86403
Phone (928) 706-9991

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1760458384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 MCCULLOCH BLVD N",
            "address_2": "SUITE 101",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035749",
            "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": "1990 MCCULLOCH BLVD N",
            "address_2": "# 101",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035749",
            "telephone_number": "928-855-5026",
            "fax_number": "928-854-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBCHUK",
        "first_name": "TANIA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "1311",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806028",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.