Provider Demographics
NPI:1972560282
Name:SOBER, THEODORE HORVAT (OD)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:HORVAT
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 1:405 STEMMERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3332
Mailing Address - Country:US
Mailing Address - Phone:410-682-2888
Mailing Address - Fax:410-682-9936
Practice Address - Street 1:405 STEMMERS RUN RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3332
Practice Address - Country:US
Practice Address - Phone:410-682-2888
Practice Address - Fax:410-682-9936
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD801138900Medicaid
T60008Medicare UPIN
MD801138900Medicaid