Healthcare Provider Details

I. General information

NPI: 1336727486
Provider Name (Legal Business Name): VILLA OPTOMETRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 LOCUST ST
WALNUT CREEK CA
94596-4118
US

IV. Provider business mailing address

2746 BAL HARBOR LN
HAYWARD CA
94545-3404
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-4362
  • Fax:
Mailing address:
  • Phone: 510-754-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON VILLA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 510-754-5438