Healthcare Provider Details

I. General information

NPI: 1952432122
Provider Name (Legal Business Name): EAST BAY EYE CENTERS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39263 MISSION BLVD STE. 1
FREMONT CA
94539-3037
US

IV. Provider business mailing address

39263 MISSION BLVD STE. 1
FREMONT CA
94539-3037
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-4500
  • Fax: 510-796-4573
Mailing address:
  • Phone: 510-796-4500
  • Fax: 510-796-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA34847
License Number StateCA

VIII. Authorized Official

Name: TAMMY A CARSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 925-830-2112