Provider Demographics
NPI:1023108743
Name:WARHOLA, SABRINA (OD)
Entity type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:
Last Name:WARHOLA
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 1:2011 S BROADWAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7886
Mailing Address - Country:US
Mailing Address - Phone:805-363-2703
Mailing Address - Fax:
Practice Address - Street 1:2011 S BROADWAY
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7886
Practice Address - Country:US
Practice Address - Phone:805-363-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167780152W00000X
CA14189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGW241AMedicare PIN