Provider Demographics
NPI:1063652485
Name:SANFORD L. KAUFMAN OD PA
Entity Type:Organization
Organization Name:SANFORD L. KAUFMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-738-5997
Mailing Address - Street 1:9804 S MILITARY TRL STE E7
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3220
Mailing Address - Country:US
Mailing Address - Phone:561-738-5997
Mailing Address - Fax:561-738-5951
Practice Address - Street 1:9804 S MILITARY TRL STE E7
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3220
Practice Address - Country:US
Practice Address - Phone:561-738-5997
Practice Address - Fax:561-738-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84106Medicare UPIN
FLBM679Medicare PIN