Provider Demographics
NPI:1336328855
Name:DAVID R. SIVAS
Entity Type:Organization
Organization Name:DAVID R. SIVAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-251-8272
Mailing Address - Street 1:5781 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4743
Mailing Address - Country:US
Mailing Address - Phone:559-251-8272
Mailing Address - Fax:559-251-4057
Practice Address - Street 1:5781 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4743
Practice Address - Country:US
Practice Address - Phone:559-251-8272
Practice Address - Fax:559-251-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6352T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406910001Medicare NSC