Provider Demographics
NPI:1104044775
Name:SEINO, VICTOR SHOTARO (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:SHOTARO
Last Name:SEINO
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 1:6802 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3166
Mailing Address - Country:US
Mailing Address - Phone:714-330-8705
Mailing Address - Fax:
Practice Address - Street 1:23161 MOULTON PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1206
Practice Address - Country:US
Practice Address - Phone:949-951-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12729T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist