Provider Demographics
NPI:1164455812
Name:CORBY, TIFFANY (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:CORBY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2306
Mailing Address - Country:US
Mailing Address - Phone:805-692-6977
Mailing Address - Fax:805-692-6987
Practice Address - Street 1:5300 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2306
Practice Address - Country:US
Practice Address - Phone:805-692-6977
Practice Address - Fax:805-692-6987
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11870T152WP0200X, 152WV0400X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
77-0049461OtherOLD TAX ID#
59-3792228OtherCURRENT TAX ID#
CA11870TOtherOPT. LISC #
CA11870TOtherOPT. LISC #
CA6057190001Medicare NSC
MC0890841OtherDEA #
CAWOP11870BMedicare UPIN