Healthcare Provider Details

I. General information

NPI: 1164345609
Provider Name (Legal Business Name): BRENTWOOD OPTOMETRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HEIDORN RANCH RD
BRENTWOOD CA
94513-5596
US

IV. Provider business mailing address

19922 SUMMERRIDGE DR
CASTRO VALLEY CA
94552-5331
US

V. Phone/Fax

Practice location:
  • Phone: 858-231-4942
  • Fax:
Mailing address:
  • Phone: 858-231-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ANNA LAM
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 858-231-4942