MEDICARE: DR. RONALD GLENN SEGER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	05772T	CA

General Provider Information

NPI Number	:	1417910290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GLENN SEGER O.D.

Provider Business Mailing Address
First Line	:	1150 W EL CAMINO REAL
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2518
Country	:	US
Telephone Number	:	650-967-5789
Fax Number	:	650-967-4106

Provider Business Practice Location Address
First Line	:	1150 W EL CAMINO REAL
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2518
Country	:	US
Telephone Number	:	650-967-5789
Fax Number	:	650-967-4106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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