Provider Demographics
NPI:1801149828
Name:SVERDLIN, BUCK (OD)
Entity type:Individual
Prefix:DR
First Name:BUCK
Middle Name:
Last Name:SVERDLIN
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 1:1427 BERKELEY ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3200
Mailing Address - Country:US
Mailing Address - Phone:310-895-3422
Mailing Address - Fax:
Practice Address - Street 1:304 MANHATTAN AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3724
Practice Address - Country:US
Practice Address - Phone:310-895-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14553152W00000X
NY007947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist