Provider Demographics
NPI:1790777381
Name:HORWITZ, SANDRA GAIL (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GAIL
Last Name:HORWITZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1523
Mailing Address - Country:US
Mailing Address - Phone:310-644-0368
Mailing Address - Fax:310-644-9984
Practice Address - Street 1:14714 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1523
Practice Address - Country:US
Practice Address - Phone:310-644-0368
Practice Address - Fax:310-644-9984
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6694TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0066940Medicaid
CASD0066940Medicaid