Provider Demographics
NPI:1447762513
Name:KEVIN CAMBRA
Entity Type:Organization
Organization Name:KEVIN CAMBRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-301-8317
Mailing Address - Street 1:4540 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7564
Mailing Address - Country:US
Mailing Address - Phone:510-301-8317
Mailing Address - Fax:510-225-2368
Practice Address - Street 1:4540 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7564
Practice Address - Country:US
Practice Address - Phone:925-833-3937
Practice Address - Fax:510-225-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier