Healthcare Provider Details

I. General information

NPI: 1619092145
Provider Name (Legal Business Name): DIANE C ALBRACHT M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21675 REDWOOD RD
CASTRO VALLEY CA
94546-6431
US

IV. Provider business mailing address

21675 REDWOOD RD
CASTRO VALLEY CA
94546-6431
US

V. Phone/Fax

Practice location:
  • Phone: 510-538-5252
  • Fax: 510-538-3884
Mailing address:
  • Phone: 510-538-5252
  • Fax: 510-538-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10136T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA25235
License Number StateCA

VIII. Authorized Official

Name: DR. DIANE C ALBRACHT
Title or Position: OPHTHALMOLOGIST
Credential: MD
Phone: 510-538-5252