Provider Demographics
NPI:1518046754
Name:SAMPSON, ALAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 PARALLEL DR
Mailing Address - Street 2:# 101
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5702
Mailing Address - Country:US
Mailing Address - Phone:707-263-3500
Mailing Address - Fax:
Practice Address - Street 1:987 PARALLEL DR
Practice Address - Street 2:# 101
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5702
Practice Address - Country:US
Practice Address - Phone:707-263-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28931Medicare UPIN
CA00A396380Medicare ID - Type Unspecified