Provider Demographics
NPI:1033470497
Name:DELA CRUZ OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DELA CRUZ OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:408-934-5938
Mailing Address - Street 1:1535 LANDESS AVE
Mailing Address - Street 2:STE 117
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8208
Mailing Address - Country:US
Mailing Address - Phone:408-934-5938
Mailing Address - Fax:408-934-5939
Practice Address - Street 1:1535 LANDESS AVE
Practice Address - Street 2:STE 117
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8208
Practice Address - Country:US
Practice Address - Phone:408-934-5938
Practice Address - Fax:408-934-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13964TLG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier