Healthcare Provider Details

I. General information

NPI: 1780045658
Provider Name (Legal Business Name): ETWARU EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 CIVIC DR SUITE G
PLEASANT HILL CA
94523-1979
US

IV. Provider business mailing address

395 CIVIC DR SUITE G
PLEASANT HILL CA
94523-1979
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-8365
  • Fax: 925-954-6939
Mailing address:
  • Phone: 925-676-8365
  • Fax: 925-954-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUPTA ETWARU
Title or Position: OWNER
Credential: MD
Phone: 925-676-8365