Healthcare Provider Details

I. General information

NPI: 1780594812
Provider Name (Legal Business Name): ANQI DENG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 PINOLE VALLEY RD
PINOLE CA
94564-1425
US

IV. Provider business mailing address

5919 KEITH AVE
OAKLAND CA
94618-1545
US

V. Phone/Fax

Practice location:
  • Phone: 510-222-6567
  • Fax:
Mailing address:
  • Phone: 801-513-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: