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NPI Code Detail

MEDICARE: DR. BUCK SVERDLIN O.D.

MEDICARE:  DR. BUCK  SVERDLIN  O.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
1152W00000XOptometrist14553CA
2152W00000XOptometrist007947NY

General Provider Information

NPI Number : 1801149828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BUCK SVERDLIN O.D.
Provider Business Mailing Address
First Line : 1427 BERKELEY ST APT 7
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-3200
Country : US
Telephone Number : 310-895-3422
Fax Number :
Provider Business Practice Location Address
First Line : 304 MANHATTAN AVE APT 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11211-3724
Country : US
Telephone Number : 310-895-3422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2012
Last Update Date : 07/12/2016

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Directions to “ DR. BUCK SVERDLIN O.D.” Practice Location

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