Provider Demographics
NPI:1255457222
Name:BOXER WACHLER, BRIAN S (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:BOXER WACHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3039
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90408-3039
Mailing Address - Country:US
Mailing Address - Phone:310-860-1900
Mailing Address - Fax:310-860-1902
Practice Address - Street 1:465 N ROXBURY DR STE 902
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4212
Practice Address - Country:US
Practice Address - Phone:310-860-1900
Practice Address - Fax:310-860-1902
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG84557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG84557BMedicare ID - Type Unspecified
W16835Medicare ID - Type Unspecified
G62891Medicare UPIN