1124104773 NPI number — RONALD G. SEGER AND JENIFER E.L. WEBB OPTOMETRISTS

Table of content: (NPI 1124104773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124104773 NPI number — RONALD G. SEGER AND JENIFER E.L. WEBB OPTOMETRISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD G. SEGER AND JENIFER E.L. WEBB OPTOMETRISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RONALD G. SEGER, O.D. AND JENIFER E. L. WEBB, O.D., FAMILY VISION CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124104773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 N SHORELINE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94043-4605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-967-5789
Provider Business Mailing Address Fax Number:
650-967-4106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 W EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-967-5789
Provider Business Practice Location Address Fax Number:
650-967-4106
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEGER
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
OPTOMETRIST/PARTNER
Authorized Official Telephone Number:
650-967-5789

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  05772T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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