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General NPI Number Information
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NPI Number | 1992889240
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Entity Type | Organization
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Legal Business Name | NORTHERN CALIFORNIA CORNEA ASSOCIATES INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 122 LA CASA VIA STE 222
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-947-0888
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Fax | 925-947-4385
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Provider Business Mailing Address
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Address Line | 122 LA CASA VIA STE 222
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-947-0888
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Fax | 925-947-4385
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Authorized Official
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Title or Position | OWNER
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Name | DAVID W VASTINE
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Credential | MD
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Telephone | 925-947-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G39000
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G17966
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License Number State | GA
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