=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073502654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CSREDER MD,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2005
-----------------------------------------------------
Last Update Date | 12/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1680 E HERNDON AVE STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-432-4200
-----------------------------------------------------
Fax | 559-432-0147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1680 E HERNDON AVE STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-432-4200
-----------------------------------------------------
Fax | 559-432-0147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHAD SHERWOOD REDER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 559-432-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------