Provider Demographics
NPI:1205821741
Name:SACHS, CAROLE L (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:L
Last Name:SACHS
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 1:200 N BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4744
Mailing Address - Country:US
Mailing Address - Phone:209-667-1234
Mailing Address - Fax:209-667-1234
Practice Address - Street 1:200 N BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4744
Practice Address - Country:US
Practice Address - Phone:209-667-1234
Practice Address - Fax:209-667-1234
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4872TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0048721Medicaid
CASD0048720Medicaid
CASD0048721Medicare PIN
CAT76546Medicare UPIN
CA6065260001Medicare NSC