Healthcare Provider Details

I. General information

NPI: 1346287414
Provider Name (Legal Business Name): OPTIMA OPHTHALMIC MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 B STREET
HAYWARD CA
94541
US

IV. Provider business mailing address

1237 B ST
HAYWARD CA
94541-2915
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number140000450
License Number StateCA

VIII. Authorized Official

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