Healthcare Provider Details

I. General information

NPI: 1023211349
Provider Name (Legal Business Name): OPTIMA OPTHALMIC MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E HAMILTON AVE STE 100
CAMPBELL CA
95008-0259
US

IV. Provider business mailing address

22634 2ND ST STE 101
HAYWARD CA
94541-4230
US

V. Phone/Fax

Practice location:
  • Phone: 408-282-8586
  • Fax:
Mailing address:
  • Phone: 510-886-5497
  • Fax: 510-886-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK R MANDEL
Title or Position: SECRETARY
Credential: MD
Phone: 510-886-3937