Provider Demographics
NPI:1659356186
Name:MEYERS, SANFORD MARK (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:MARK
Last Name:MEYERS
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 1:2454 E DEMPSTER ST
Mailing Address - Street 2:400
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5315
Mailing Address - Country:US
Mailing Address - Phone:847-299-0700
Mailing Address - Fax:847-390-0616
Practice Address - Street 1:2454 E DEMPSTER ST
Practice Address - Street 2:400
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5315
Practice Address - Country:US
Practice Address - Phone:847-299-0700
Practice Address - Fax:847-390-0616
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095435207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095435Medicaid
L73168Medicare ID - Type Unspecified
IL036095435Medicaid