Provider Demographics
NPI:1124104773
Name:RONALD G. SEGER AND JENIFER E.L. WEBB OPTOMETRISTS
Entity type:Organization
Organization Name:RONALD G. SEGER AND JENIFER E.L. WEBB OPTOMETRISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SEGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:650-967-5789
Mailing Address - Street 1:419 N SHORELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4605
Mailing Address - Country:US
Mailing Address - Phone:650-967-5789
Mailing Address - Fax:650-967-4106
Practice Address - Street 1:1150 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2518
Practice Address - Country:US
Practice Address - Phone:650-967-5789
Practice Address - Fax:650-967-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05772T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB158Medicare PIN