Healthcare Provider Details

I. General information

NPI: 1184812851
Provider Name (Legal Business Name): DELTA EYE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W GRANT LINE RD SUITE 100
TRACY CA
95377-7330
US

IV. Provider business mailing address

2160 W GRANT LINE RD SUITE 100
TRACY CA
95377-7330
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-2227
  • Fax:
Mailing address:
  • Phone: 209-835-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CINDY DAASCH
Title or Position: MANAGER
Credential:
Phone: 209-478-1797