Provider Demographics
NPI:1700884525
Name:BURKLEY, SANDLER L (OD)
Entity type:Individual
Prefix:DR
First Name:SANDLER
Middle Name:L
Last Name:BURKLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 GULF RESEARCH LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4555
Mailing Address - Country:US
Mailing Address - Phone:239-418-0999
Mailing Address - Fax:239-418-0091
Practice Address - Street 1:3020 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-2438
Practice Address - Country:US
Practice Address - Phone:239-418-0999
Practice Address - Fax:239-418-0091
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-07-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLOPC1074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084831000Medicaid
FL084831000Medicaid
FL19285XMedicare PIN
FL19285WMedicare PIN