Provider Demographics
NPI:1346603651
Name:DELTA EYECARE
Entity Type:Organization
Organization Name:DELTA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANGANER
Authorized Official - Prefix:MS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:THANHBINH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-648-7497
Mailing Address - Street 1:31087 COURTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1718
Mailing Address - Country:US
Mailing Address - Phone:510-796-7497
Mailing Address - Fax:510-796-4777
Practice Address - Street 1:5763 JENSEN RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5015
Practice Address - Country:US
Practice Address - Phone:510-678-7497
Practice Address - Fax:510-796-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81-1936800332G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332G00000XSuppliersEye Bank