Healthcare Provider Details

I. General information

NPI: 1861915142
Provider Name (Legal Business Name): BDHV MEDICAL GROUP OF CALIFORNIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 10/25/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MERIDIAN AVE
SAN JOSE CA
95126-2903
US

IV. Provider business mailing address

43 BIANCO
IRVINE CA
92618-0106
US

V. Phone/Fax

Practice location:
  • Phone: 408-869-3400
  • Fax:
Mailing address:
  • Phone: 352-256-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: PATRICK BYRNE
Title or Position: OWNER
Credential:
Phone: 443-226-8855