Provider Demographics
NPI:1285837484
Name:OPTIMA OPHTHALMIC MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:OPTIMA OPHTHALMIC MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGLONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-886-3937
Mailing Address - Street 1:1229 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2915
Mailing Address - Country:US
Mailing Address - Phone:510-886-3937
Mailing Address - Fax:510-886-4465
Practice Address - Street 1:1237 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2915
Practice Address - Country:US
Practice Address - Phone:510-886-5497
Practice Address - Fax:510-886-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42418207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80788ZMedicaid
CAZZZ80788ZMedicaid
CA0591550002Medicare NSC
CA180013411Medicare PIN
CAI10572Medicare UPIN
CAA48953Medicare UPIN
CAP00139492Medicare PIN
CA180041615Medicare PIN
CA180031838Medicare PIN
CAG20554Medicare UPIN
CAZZZ80788ZMedicare PIN