Provider Demographics
NPI:1306861612
Name:ZARDO, DELMA FARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:DELMA
Middle Name:FARIA
Last Name:ZARDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DELMA
Other - Middle Name:GOULART
Other - Last Name:FARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2421 KISKA DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7913
Mailing Address - Country:US
Mailing Address - Phone:209-605-0442
Mailing Address - Fax:209-524-7985
Practice Address - Street 1:810 STANDIFORD AVE STE 4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0977
Practice Address - Country:US
Practice Address - Phone:209-524-7870
Practice Address - Fax:209-524-7985
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12678T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126780Medicaid
CAV10942Medicare UPIN
CASD0126780Medicaid
CASD0126780Medicare PIN