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General NPI Number Information
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NPI Number | 1063417814
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Entity Type | Individual
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Provider Name | SANFORD LEWIS SEVERIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 5801 NORRIS CANYON RD STE 200
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City | SAN RAMON
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State | CA
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Zip | 94583-5440
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Country | US
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Telephone | 925-830-8823
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Fax | 925-866-6610
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Provider Business Mailing Address
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Address Line | 5801 NORRIS CANYON RD STE 200
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City | SAN RAMON
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State | CA
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Zip | 94583-5440
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Country | US
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Telephone | 925-830-8823
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Fax | 925-866-6610
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OOC236190
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License Number State | CA
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