Provider Demographics
NPI:1740496157
Name:ULSETH, DANIEL BARD (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BARD
Last Name:ULSETH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2203 DEL PASO BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3101
Mailing Address - Country:US
Mailing Address - Phone:916-299-3277
Mailing Address - Fax:800-957-5816
Practice Address - Street 1:2203 DEL PASO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3101
Practice Address - Country:US
Practice Address - Phone:916-299-3277
Practice Address - Fax:800-957-5816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0083380Medicaid