Individual
ROBERT LYTTON HETLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1395 SAN CARLOS AVE, SUITE A, SAN CARLOS, CA 94070-2388
(650) 802-9921
(650) 802-9923
Mailing address
1395 SAN CARLOS AVE, SUITE A, SAN CARLOS, CA 94070-2388
(650) 802-9921
(650) 802-9923
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A22540
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A225400
—
CA
01
—
11002645
CAQH PROVIDER ID
CA
01
—
4056691
AETNA ID
CA
01
—
P00205050
RAILROAD MEDICARE
CA
Enumeration date
07/11/2006
Last updated
06/22/2016
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