Provider Demographics
NPI:1689287880
Name:SABATINI, MILES (OD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:
Last Name:SABATINI
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 1:295 LENOX AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4655
Mailing Address - Country:US
Mailing Address - Phone:818-522-8864
Mailing Address - Fax:
Practice Address - Street 1:4000 CIVIC CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5232
Practice Address - Country:US
Practice Address - Phone:415-444-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist