Provider Demographics
NPI:1699821967
Name:SIU, CESAR ENRIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:ENRIQUE
Last Name:SIU
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 1:5923 REMER TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3631
Mailing Address - Country:US
Mailing Address - Phone:510-796-1990
Mailing Address - Fax:
Practice Address - Street 1:33800 ALVARADO NILES RD
Practice Address - Street 2:3
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4359
Practice Address - Country:US
Practice Address - Phone:510-487-5856
Practice Address - Fax:510-487-3772
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8860T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088600Medicaid
CASD0088600Medicare ID - Type Unspecified