MEDICARE: DR. JEFFREY MERRICK SAGE D.O.

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	20A5971	CA

General Provider Information

NPI Number	:	1114926730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MERRICK SAGE D.O.

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BOULEVARD
Second Line	:	SUITE 1600
City	:	LOS ANGELES
State	:	CA
Zip	:	90017
Country	:	US
Telephone Number	:	213-250-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1600
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-250-5333
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/24/2024

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