Provider Demographics
NPI:1134194657
Name:SIVAS, DAVID RICHARD
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:SIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5781 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4743
Mailing Address - Country:US
Mailing Address - Phone:559-251-8272
Mailing Address - Fax:559-251-4057
Practice Address - Street 1:5781 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4743
Practice Address - Country:US
Practice Address - Phone:559-251-8272
Practice Address - Fax:559-251-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6352T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3156OtherMESC
CA46462OtherSAFEGARD ID NUMBER
CASD0063520Medicaid
CA211241OtherEYEMED
CA3156OtherMESC
CAT10299Medicare UPIN
0406910001Medicare NSC