Healthcare Provider Details

I. General information

NPI: 1528147048
Provider Name (Legal Business Name): WALNUT CREEK OPTOMETRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE 312
WALNUT CREEK CA
94596-4963
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE 312
WALNUT CREEK CA
94596-4963
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-4313
  • Fax: 925-943-1907
Mailing address:
  • Phone: 925-934-4313
  • Fax: 925-943-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10544T
License Number StateCA

VIII. Authorized Official

Name: DR. BACH-KIM NGUYEN
Title or Position: OPTOMETRIST /OWNER
Credential: O.D.
Phone: 925-934-4313