MEDICARE: DR. JEFFREY R SANDLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	026266	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568425171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY R SANDLER M.D.

Provider Business Mailing Address
First Line	:	4699 MAIN ST
Second Line	:	SUITE 106
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1830
Country	:	US
Telephone Number	:	303-374-8182
Fax Number	:	203-374-2626

Provider Business Practice Location Address
First Line	:	4699 MAIN ST
Second Line	:	SUITE 106
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1830
Country	:	US
Telephone Number	:	303-374-8182
Fax Number	:	203-374-2626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/27/2008

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