Provider Demographics
NPI:1841464658
Name:DR SAUL MENDELSOHN OPTOMETRIST A PROFESSIONAL CORP
Entity type:Organization
Organization Name:DR SAUL MENDELSOHN OPTOMETRIST A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-285-0084
Mailing Address - Street 1:5478 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1940
Mailing Address - Country:US
Mailing Address - Phone:559-447-4990
Mailing Address - Fax:559-447-4994
Practice Address - Street 1:5478 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1940
Practice Address - Country:US
Practice Address - Phone:559-447-4990
Practice Address - Fax:559-447-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4968T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049680Medicaid
CAT09835Medicare UPIN
CA0899840001Medicare NSC