Provider Demographics
NPI:1366536492
Name:SOBCZAK, THERESIA LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:THERESIA
Middle Name:LOUISE
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2790 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8314
Mailing Address - Country:US
Mailing Address - Phone:231-347-4318
Mailing Address - Fax:
Practice Address - Street 1:1850 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-439-0078
Practice Address - Fax:231-439-0080
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist