Healthcare Provider Details

I. General information

NPI: 1285642801
Provider Name (Legal Business Name): DELTA VISTA OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 BRENTWOOD BLVD STE F
BRENTWOOD CA
94513-1300
US

IV. Provider business mailing address

8440 BRENTWOOD BLVD STE F
BRENTWOOD CA
94513-1300
US

V. Phone/Fax

Practice location:
  • Phone: 924-634-0303
  • Fax: 925-634-0338
Mailing address:
  • Phone: 925-634-0303
  • Fax: 925-634-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 8323 TPL
License Number StateCA

VIII. Authorized Official

Name: DR. CAROL A BUCHANAN
Title or Position: OWNER
Credential: OD
Phone: 925-634-0303