Provider Demographics
NPI:1285697888
Name:SOBER, JASON KEITH (OD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:KEITH
Last Name:SOBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841C BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2403
Mailing Address - Country:US
Mailing Address - Phone:410-682-2888
Mailing Address - Fax:410-682-9936
Practice Address - Street 1:8841C BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2403
Practice Address - Country:US
Practice Address - Phone:410-682-2888
Practice Address - Fax:410-682-9936
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD745162800Medicaid
MD787L86IDMedicare ID - Type Unspecified
MD745162800Medicaid