MEDICARE: CENTRAL COAST RETINA INC

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
2	207WX0107X	Retina Specialist (Ophthalmology) Physician

General Provider Information

NPI Number	:	1558986455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL COAST RETINA INC

Provider Business Mailing Address
First Line	:	504 E GRAND AVE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2622
Country	:	US
Telephone Number	:	805-876-3050
Fax Number	:	805-876-3052

Provider Business Practice Location Address
First Line	:	504 E GRAND AVE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2622
Country	:	US
Telephone Number	:	805-876-3050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAGUI WASSEF SEDEEK
Credential	:	MD
Telephone Number	:	805-876-3050

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	04/24/2026

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Directions to “CENTRAL COAST RETINA INC ” Practice Location

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