Provider Demographics
NPI:1417910290
Name:SEGER, RONALD GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
Last Name:SEGER
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 1:1150 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2518
Mailing Address - Country:US
Mailing Address - Phone:650-967-5789
Mailing Address - Fax:650-967-4106
Practice Address - Street 1:1150 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2518
Practice Address - Country:US
Practice Address - Phone:650-967-5789
Practice Address - Fax:650-967-4106
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05772T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057720Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #