Provider Demographics
NPI:1932102415
Name:SANDLER, BRADLEY JAY (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAY
Last Name:SANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1360 BURTON DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3557
Mailing Address - Country:US
Mailing Address - Phone:707-422-6500
Mailing Address - Fax:707-422-6556
Practice Address - Street 1:1345 GATEWAY BLVD
Practice Address - Street 2:STE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6904
Practice Address - Country:US
Practice Address - Phone:707-422-6500
Practice Address - Fax:707-422-6556
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2014-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG53878207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G538781Medicaid
CA0533490002Medicare NSC
CA00G538780Medicare ID - Type Unspecified
CA00G538781Medicaid