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General NPI Number Information
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NPI Number | 1164858783
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Entity Type | Organization
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Legal Business Name | SEIJU E. TERADA, O.D., INC.
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 10130 WARNER AVE STE J
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1619
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Country | US
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Telephone | 714-965-5130
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Fax | 714-965-8265
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Provider Business Mailing Address
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Address Line | 10130 WARNER AVE STE J
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1619
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Country | US
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Telephone | 714-965-5130
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Fax | 714-965-8265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEIJU E TERADA
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Credential | O.D.
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Telephone | 714-965-5130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 7856T
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License Number State | CA
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