MEDICARE: DELA CRUZ OPTOMETRIC CORPORATION

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	332H00000X	Eyewear Supplier	13964TLG	CA

General Provider Information

NPI Number	:	1033470497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELA CRUZ OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	1535 LANDESS AVE
Second Line	:	STE 117
City	:	MILPITAS
State	:	CA
Zip	:	95035-8208
Country	:	US
Telephone Number	:	408-934-5938
Fax Number	:	408-934-5939

Provider Business Practice Location Address
First Line	:	1535 LANDESS AVE
Second Line	:	STE 117
City	:	MILPITAS
State	:	CA
Zip	:	95035-8208
Country	:	US
Telephone Number	:	408-934-5938
Fax Number	:	408-934-5939

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	EMMANUEL DELA CRUZ II
Credential	:	O.D.
Telephone Number	:	408-934-5938

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	06/01/2012

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