Provider Demographics
NPI:1952485427
Name:BELAJIC, ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BELAJIC
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 1:3211 FORTUNE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9245
Mailing Address - Country:US
Mailing Address - Phone:530-885-6241
Mailing Address - Fax:530-885-0144
Practice Address - Street 1:3211 FORTUNE CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9245
Practice Address - Country:US
Practice Address - Phone:530-885-6241
Practice Address - Fax:530-885-0144
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5814TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058140Medicaid
MB0644547OtherDEA #
CASD0058140Medicaid
SD0058140Medicare PIN