Provider Demographics
NPI:1366443277
Name:MENDELSON, MOSHE (OD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W FREMONT AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3000
Mailing Address - Country:US
Mailing Address - Phone:408-739-6200
Mailing Address - Fax:408-739-2439
Practice Address - Street 1:1010 W FREMONT AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3000
Practice Address - Country:US
Practice Address - Phone:408-739-6200
Practice Address - Fax:408-739-2439
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9629T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0096290Medicare ID - Type UnspecifiedMENDELSON'S MEDICARE #
CAU25451Medicare UPIN