Healthcare Provider Details

I. General information

NPI: 1740710425
Provider Name (Legal Business Name): BRADLEY J SANDLER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 GATEWAY BLVD
FAIRFIELD CA
94533-6904
US

IV. Provider business mailing address

1360 BURTON DR
VACAVILLE CA
95687-3557
US

V. Phone/Fax

Practice location:
  • Phone: 707-422-6500
  • Fax: 707-422-6556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberG53878
License Number StateCA

VIII. Authorized Official

Name: MRS. KAREN M SANDLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-422-6500