Provider Demographics
NPI:1699964577
Name:DAVIDSON, SANFORD STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:STEPHEN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 AVENIDA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-540-4433
Mailing Address - Fax:310-316-4331
Practice Address - Street 1:215 AVENIDA DEL NORTE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-540-4433
Practice Address - Fax:310-316-4331
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23756207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0899910001Medicare NSC
WG23756BMedicare PIN
CAA42059Medicare UPIN