Provider Demographics
NPI:1942228929
Name:SIU, ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
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 1:290 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4791
Mailing Address - Country:US
Mailing Address - Phone:510-451-9157
Mailing Address - Fax:510-451-9160
Practice Address - Street 1:290 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4791
Practice Address - Country:US
Practice Address - Phone:510-451-9157
Practice Address - Fax:510-451-9160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057801Medicaid
CASD0057801Medicaid
CASD0057801Medicare PIN