Healthcare Provider Details

I. General information

NPI: 1508791633
Provider Name (Legal Business Name): LUNAR VIEW OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COUNTRY CLUB DR STE 1A
MORAGA CA
94556-1954
US

IV. Provider business mailing address

920 COUNTRY CLUB DR STE 1A
MORAGA CA
94556-1954
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-3939
  • Fax:
Mailing address:
  • Phone: 510-269-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHRUKH SHAIQ CHISHTY QAWAM
Title or Position: OPTOMETRIST
Credential: OD
Phone: 510-269-3939