Provider Demographics
NPI:1093791188
Name:CONTRA COSTA EYE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CONTRA COSTA EYE MEDICAL CENTER INC
Other - Org Name:DEGNAN EYE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:AXEXANDRA
Authorized Official - Last Name:KINDY-DEGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-687-8280
Mailing Address - Street 1:2222 EAST ST
Mailing Address - Street 2:STE 365
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2056
Mailing Address - Country:US
Mailing Address - Phone:925-687-8280
Mailing Address - Fax:925-687-9744
Practice Address - Street 1:2222 EAST ST
Practice Address - Street 2:STE 365
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2056
Practice Address - Country:US
Practice Address - Phone:925-687-8280
Practice Address - Fax:925-687-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14505ZMedicare ID - Type Unspecified