Provider Demographics
NPI:1952408429
Name:SABIN, DAVID BRENDON (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRENDON
Last Name:SABIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S DALE MABRY HWY
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5035
Mailing Address - Country:US
Mailing Address - Phone:813-843-2653
Mailing Address - Fax:
Practice Address - Street 1:1155 S DALE MABRY HWY
Practice Address - Street 2:SUITE 16
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5035
Practice Address - Country:US
Practice Address - Phone:813-843-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36070OtherMEDICARE PTAN
FL000796700Medicaid
FL000796700Medicaid