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General NPI Number Information
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NPI Number | 1104044775
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Entity Type | Individual
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Provider Name | VICTOR SHOTARO SEINO O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2007
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 23161 MOULTON PKWY
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1206
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Country | US
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Telephone | 949-951-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 GLEN DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3166
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Country | US
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Telephone | 714-330-8705
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12729T
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License Number State | CA
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