Provider Demographics
NPI:1982631941
Name:SIERRA VIEW MEDICAL EYE., INC
Entity Type:Organization
Organization Name:SIERRA VIEW MEDICAL EYE., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-272-3411
Mailing Address - Street 1:400 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5089
Mailing Address - Country:US
Mailing Address - Phone:530-272-3411
Mailing Address - Fax:530-272-3474
Practice Address - Street 1:400 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5089
Practice Address - Country:US
Practice Address - Phone:530-272-3411
Practice Address - Fax:530-272-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982631941Medicaid
CA0371040001Medicare NSC
CA1982631941Medicaid