Provider Demographics
NPI:1831145739
Name:THEODORE, SHARON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:M
Last Name:THEODORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:MCCAFFERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 JAMES WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2874
Mailing Address - Country:US
Mailing Address - Phone:805-876-3050
Mailing Address - Fax:805-876-3052
Practice Address - Street 1:300 JAMES WAY STE 150
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2874
Practice Address - Country:US
Practice Address - Phone:805-876-3050
Practice Address - Fax:805-876-3052
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91327207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00 A913270Medicaid
CA00 A913270Medicaid
CA00A913270Medicare PIN