Provider Demographics
NPI:1083779938
Name:DRENTH, DONALD D (OD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:DRENTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20852
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-0852
Mailing Address - Country:US
Mailing Address - Phone:408-268-9756
Mailing Address - Fax:408-268-1168
Practice Address - Street 1:2200 EASTRIDGE LOOP
Practice Address - Street 2:STE 1078
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1410
Practice Address - Country:US
Practice Address - Phone:408-270-6161
Practice Address - Fax:408-270-6176
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4495T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO044951Medicare ID - Type Unspecified
CAT09678Medicare UPIN