Healthcare Provider Details

I. General information

NPI: 1558986455
Provider Name (Legal Business Name): CENTRAL COAST RETINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E GRAND AVE
ARROYO GRANDE CA
93420-2622
US

IV. Provider business mailing address

504 E GRAND AVE
ARROYO GRANDE CA
93420-2622
US

V. Phone/Fax

Practice location:
  • Phone: 805-876-3050
  • Fax:
Mailing address:
  • Phone: 805-876-3050
  • Fax: 805-876-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAGUI WASSEF SEDEEK
Title or Position: OWNER
Credential: MD
Phone: 805-876-3050