Provider Demographics
NPI:1578233359
Name:MENDOZA, MARLON DANILO (OD)
Entity Type:Individual
Prefix:DR
First Name:MARLON
Middle Name:DANILO
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 TARA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2739
Mailing Address - Country:US
Mailing Address - Phone:510-260-3026
Mailing Address - Fax:
Practice Address - Street 1:225 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8693
Practice Address - Country:US
Practice Address - Phone:718-384-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009637152W00000X
CA34896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist