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Contact Information

ROBERT B WIDERSPAN, OD
4015 CAPITOLA RD
SANTA CRUZ, CA95062
 Phone: 831-475-8639
 Fax: 831-464-1075
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for ROBERT B WIDERSPAN · (Male)

NPI # 1295944452
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 05/22/2007
Last updated 04/24/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 8047T
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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