Provider Demographics
NPI:1710057195
Name:BISEK, DONALD ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALAN
Last Name:BISEK
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 1:2801 WATERMAN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-427-5550
Mailing Address - Fax:707-427-5551
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-427-5550
Practice Address - Fax:707-427-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9890T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9890TOtherCALIF OPTOMETRY #
CASD0098900Medicaid
CASD0098900Medicaid