Provider Demographics
NPI:1376563908
Name:MENDELSOHN, SAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:SAUL
Other - Middle Name:
Other - Last Name:MENDELSOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD A PROF CORP
Mailing Address - Street 1:5478 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1940
Mailing Address - Country:US
Mailing Address - Phone:559-447-4990
Mailing Address - Fax:559-447-4994
Practice Address - Street 1:5478 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1940
Practice Address - Country:US
Practice Address - Phone:559-447-4990
Practice Address - Fax:559-447-4994
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4968T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049681Medicaid
CA4968TOtherCALIFORNIA OD LICENSE
CAT09835Medicare UPIN
CASD0049681Medicaid