Provider Demographics
NPI:1225241219
Name:EILEEN M LINDER OPTOMETRIST INC
Entity Type:Organization
Organization Name:EILEEN M LINDER OPTOMETRIST INC
Other - Org Name:EYE TO EYE OPTOMETRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-757-7676
Mailing Address - Street 1:4051 LONE TREE WAY STE E
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6204
Mailing Address - Country:US
Mailing Address - Phone:925-757-7676
Mailing Address - Fax:925-757-0652
Practice Address - Street 1:4051 LONE TREE WAY STE E
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6204
Practice Address - Country:US
Practice Address - Phone:925-757-7676
Practice Address - Fax:925-281-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09414T152W00000X
CA12522T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6896Medicaid
CABF528AMedicare PIN
CAU26988Medicare UPIN
CA6896Medicaid
CABF529ZMedicare PIN