Provider Demographics
NPI:1407964679
Name:DELTA EYE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:DELTA EYE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-478-1797
Mailing Address - Street 1:1617 SAINT MARKS PLZ
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6423
Mailing Address - Country:US
Mailing Address - Phone:209-478-1797
Mailing Address - Fax:209-478-1224
Practice Address - Street 1:1617 SAINT MARKS PLZ
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6423
Practice Address - Country:US
Practice Address - Phone:209-478-1797
Practice Address - Fax:209-478-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE8123OtherRAILROAD
CAZZZ72835ZMedicaid
CA0681060001Medicare NSC
CAZZZ72835ZMedicare PIN