MEDICARE: DR. DAVID ALLEN SACKIN 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
1	152W00000X	Optometrist	OPT5000TPA	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1289930001	OTHER	CA	DMEPOS SUPPLIER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891897195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLEN SACKIN O.D.

Provider Business Mailing Address
First Line	:	8414 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-894-6408
Fax Number	:	818-894-6400

Provider Business Practice Location Address
First Line	:	8414 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-894-6408
Fax Number	:	818-894-6400

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	11/02/2010

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