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General NPI Number Information
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NPI Number | 1346603651
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Entity Type | Organization
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Legal Business Name | DELTA EYECARE
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 5763 JENSEN RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94552-5015
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Country | US
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Telephone | 510-678-7497
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Fax | 510-796-4777
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Provider Business Mailing Address
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Address Line | 31087 COURTHOUSE DR
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City | UNION CITY
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State | CA
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Zip | 94587-1718
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Country | US
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Telephone | 510-796-7497
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Fax | 510-796-4777
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Authorized Official
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Title or Position | OWNER/ MANGANER
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Name | MS. BIANCA THANHBINH PHAM
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Credential |
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Telephone | 510-648-7497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332G00000X
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Taxonomy Name | Eye Bank
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License Number | 81-1936800
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License Number State | CA
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