Provider Demographics
NPI:1669885661
Name:BRADLEY J SANDLER MD INC
Entity type:Organization
Organization Name:BRADLEY J SANDLER MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:YINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-422-6500
Mailing Address - Street 1:1360 BURTON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3560
Mailing Address - Country:US
Mailing Address - Phone:707-422-6500
Mailing Address - Fax:707-422-6556
Practice Address - Street 1:1360 BURTON DR STE 150
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3560
Practice Address - Country:US
Practice Address - Phone:707-422-6500
Practice Address - Fax:707-422-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92000388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52618Medicare UPIN
CACA124725Medicare PIN