Provider Demographics
NPI:1073817060
Name:CASTRO VALLEY OPTOMETRY GROUP, INC.
Entity Type:Organization
Organization Name:CASTRO VALLEY OPTOMETRY GROUP, INC.
Other - Org Name:CASTRO VALLEY OPTOMETRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MS./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:QUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-881-8343
Mailing Address - Street 1:4041 E CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-4840
Mailing Address - Country:US
Mailing Address - Phone:510-881-8343
Mailing Address - Fax:510-881-8501
Practice Address - Street 1:4041 E CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-4840
Practice Address - Country:US
Practice Address - Phone:510-881-8343
Practice Address - Fax:510-881-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEH029AMedicare PIN