Provider Demographics
NPI:1568518637
Name:SACKS, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1125 S BEVERLY DR
Mailing Address - Street 2:SUITE 710
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1148
Mailing Address - Country:US
Mailing Address - Phone:310-275-6179
Mailing Address - Fax:310-278-7592
Practice Address - Street 1:1125 S BEVERLY DR
Practice Address - Street 2:SUITE 710
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1148
Practice Address - Country:US
Practice Address - Phone:310-275-6179
Practice Address - Fax:310-278-7592
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64460207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644600Medicaid
CAE89336Medicare UPIN
CAWG64460AMedicare PIN