Provider Demographics
NPI:1821284092
Name:FELDMAN, SANDY T (MD,)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:T
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1830
Mailing Address - Country:US
Mailing Address - Phone:858-452-3937
Mailing Address - Fax:858-452-3933
Practice Address - Street 1:6255 LUSK BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3763
Practice Address - Country:US
Practice Address - Phone:858-452-3937
Practice Address - Fax:858-452-3933
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057688207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G576881Medicaid
CAF02062Medicare UPIN
CA00G576881Medicaid