MEDICARE: DR. SANFORD LEWIS SEVERIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	OOC236190	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	180046438	OTHER	CA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0708	OTHER	CA	MEDICAL EYE SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ZZZ057067	OTHER	CA	BLUE CROSS
4	ZZZ05706Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1063417814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANFORD LEWIS SEVERIN M.D.

Provider Business Mailing Address
First Line	:	5801 NORRIS CANYON RD
Second Line	:	STE 200
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5440
Country	:	US
Telephone Number	:	925-830-8823
Fax Number	:	925-866-6610

Provider Business Practice Location Address
First Line	:	5801 NORRIS CANYON RD
Second Line	:	STE 200
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5440
Country	:	US
Telephone Number	:	925-830-8823
Fax Number	:	925-866-6610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/08/2016

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Directions to “ DR. SANFORD LEWIS SEVERIN M.D.” Practice Location

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