MEDICARE: DEBORAH DELEON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11046T	CA

General Provider Information

NPI Number	:	1215122486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH DELEON

Provider Business Mailing Address
First Line	:	3714 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-1330
Country	:	US
Telephone Number	:	510-530-2330
Fax Number	:	510-530-4947

Provider Business Practice Location Address
First Line	:	3714 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-1330
Country	:	US
Telephone Number	:	510-530-2330
Fax Number	:	510-530-4947

Authorized Official
Title or Position	:	OPTOMETRIST/SOLE PROPRIETOR
Name	:	DR. DEBORAH ELLEN DELEON
Credential	:	OD
Telephone Number	:	510-530-2330

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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