Healthcare Provider Details

I. General information

NPI: 1881558856
Provider Name (Legal Business Name): BAY AREA RETINA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRAL BLVD STE C
BRENTWOOD CA
94513-2227
US

IV. Provider business mailing address

PO BOX 748930
LOS ANGELES CA
90074-8930
US

V. Phone/Fax

Practice location:
  • Phone: 800-573-8462
  • Fax: 925-943-6880
Mailing address:
  • Phone: 925-265-8324
  • Fax: 916-938-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TUSHAR RANCHOD
Title or Position: PARTNER
Credential: MD
Phone: 925-943-6800