Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 11870T | CA |
N | 152WP0200X | Pediatric Optomitrist | 11870T | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 11870T | CA |
NPI | 1164455812 |
---|---|
Provider Name | Dr. Tiffany Corby |
First Address | Santa Barbara, CA 93111-2306 |
Second Address | Santa Barbara, CA 93111-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 24/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11870T | OPT. LISC # (01) | CA |
59-3792228 | CURRENT TAX ID# (01) | |
77-0049461 | OLD TAX ID# (01) | |
MC0890841 | DEA # (01) | |
WOP11870B | (02) | CA |