Provider Demographics
NPI:1558986455
Name:CENTRAL COAST RETINA INC
Entity Type:Organization
Organization Name:CENTRAL COAST RETINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGUI
Authorized Official - Middle Name:WASSEF
Authorized Official - Last Name:SEDEEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-876-3050
Mailing Address - Street 1:821 E CHAPEL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4618
Mailing Address - Country:US
Mailing Address - Phone:805-876-3050
Mailing Address - Fax:805-876-3052
Practice Address - Street 1:821 E CHAPEL ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4618
Practice Address - Country:US
Practice Address - Phone:805-876-3050
Practice Address - Fax:805-876-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty