Provider Demographics
NPI:1881691327
Name:SOBOL, WARREN M (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:M
Last Name:SOBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 MAYFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE STE 3200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052646207WX0107X, 207W00000X
PAMD417521207W00000X, 207WX0107X
NC30488207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0819896Medicaid
OH0819896Medicaid
1528219001OtherCIGNA
311011691028OtherCARESOURCE
4212394OtherAETNA
0801969OtherEVERCARE
OHSO0690671Medicare PIN
352118759OtherMEDICAL MUTUAL
D52646OtherHUMANA
E07329Medicare UPIN
OH0819896Medicaid
314088OtherAMERIGROUP
180013023Medicare PIN