MEDICARE: UC BERKELEY EMERYVILLE EYE CENTER

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

General Provider Information

NPI Number	:	1891654091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UC BERKELEY EMERYVILLE EYE CENTER

Provider Business Mailing Address
First Line	:	3840 SAN PABLO AVE
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-3805
Country	:	US
Telephone Number	:	510-642-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 SAN PABLO AVENUE
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608
Country	:	US
Telephone Number	:	510-642-2020
Fax Number	:

Authorized Official
Title or Position	:	SCHOOL OF OPTOMETRY CFO
Name	:	LUIS FERNANDO RUIZ
Credential	:
Telephone Number	:	510-717-2110

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	06/04/2026

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