Provider Demographics
NPI:1558771477
Name:DELTA OPTICAL
Entity Type:Organization
Organization Name:DELTA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:510-796-4732
Mailing Address - Street 1:35149 NEWARK BLVD
Mailing Address - Street 2:SUITE#B
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1209
Mailing Address - Country:US
Mailing Address - Phone:510-796-4732
Mailing Address - Fax:510-796-4777
Practice Address - Street 1:35149 NEWARK BLVD
Practice Address - Street 2:SUITE#B
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1209
Practice Address - Country:US
Practice Address - Phone:510-796-4732
Practice Address - Fax:510-796-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty