Provider Demographics
NPI:1164858783
Name:SEIJU E. TERADA, O.D., INC.
Entity Type:Organization
Organization Name:SEIJU E. TERADA, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEIJU
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-965-5130
Mailing Address - Street 1:10130 WARNER AVE STE J
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1619
Mailing Address - Country:US
Mailing Address - Phone:714-965-5130
Mailing Address - Fax:714-965-8265
Practice Address - Street 1:10130 WARNER AVE STE J
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1619
Practice Address - Country:US
Practice Address - Phone:714-965-5130
Practice Address - Fax:714-965-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7856T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU36998Medicare UPIN
CAOP7856Medicare PIN