Healthcare Provider Details

I. General information

NPI: 1174658983
Provider Name (Legal Business Name): RONALD S SHIGIO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N WIGET LN SUITE 120
WALNUT CREEK CA
94598-2435
US

IV. Provider business mailing address

325 N WIGET LN SUITE 120
WALNUT CREEK CA
94598-2435
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-6870
  • Fax: 925-937-3282
Mailing address:
  • Phone: 925-937-6870
  • Fax: 925-937-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: