Provider Demographics
NPI:1437146206
Name:DANVILLE-SAN RAMON EYE MEDICAL CORP
Entity Type:Organization
Organization Name:DANVILLE-SAN RAMON EYE MEDICAL CORP
Other - Org Name:ROGER A GREENWALD MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:SUSANA
Authorized Official - Last Name:PINILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-837-6428
Mailing Address - Street 1:909 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:STE 114
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4038
Mailing Address - Country:US
Mailing Address - Phone:925-837-6428
Mailing Address - Fax:925-837-1403
Practice Address - Street 1:909 SAN RAMON VALLEY BLVD
Practice Address - Street 2:STE 114
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4038
Practice Address - Country:US
Practice Address - Phone:925-837-6428
Practice Address - Fax:925-837-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS4583OtherMEDICARE RR
CAZZZ57540ZOtherBLUE SHIELD
CAGR0084620Medicaid
CA0311270002Medicare NSC
CACS4583OtherMEDICARE RR