Provider Demographics
NPI:1780890962
Name:RICHARD SEQUEIRA ET AL PTRS
Entity type:Organization
Organization Name:RICHARD SEQUEIRA ET AL PTRS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-881-8343
Mailing Address - Street 1:4041 E CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-4840
Mailing Address - Country:US
Mailing Address - Phone:510-881-8343
Mailing Address - Fax:510-881-8501
Practice Address - Street 1:4041 E CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-4840
Practice Address - Country:US
Practice Address - Phone:510-881-8343
Practice Address - Fax:510-881-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 3083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0262880002Medicare NSC
CAZZZ31261ZMedicare ID - Type UnspecifiedGROUP NUMBER