Provider Demographics
NPI:1023211349
Name:OPTIMA OPTHALMIC MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:OPTIMA OPTHALMIC MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-886-3937
Mailing Address - Street 1:22634 2ND ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4230
Mailing Address - Country:US
Mailing Address - Phone:510-886-5497
Mailing Address - Fax:510-886-4465
Practice Address - Street 1:50 E HAMILTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0259
Practice Address - Country:US
Practice Address - Phone:408-282-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMA OPHTHALMIC MEDICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80788ZMedicaid
CA180031838Medicare PIN
CAP00139492Medicare PIN
CAZZZ80788ZMedicaid
CA180013411Medicare PIN
CAZZZ22528ZMedicare PIN
CAA68266Medicare UPIN
CAG20554Medicare UPIN
CAE38507Medicare UPIN
CA180041615Medicare PIN