Provider Demographics
NPI:1598304313
Name:EASTRIDGE OPTOMETRY
Entity Type:Organization
Organization Name:EASTRIDGE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-504-2028
Mailing Address - Street 1:6839 ELVERTON DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1110
Mailing Address - Country:US
Mailing Address - Phone:510-504-2028
Mailing Address - Fax:
Practice Address - Street 1:2210 TULLY RD
Practice Address - Street 2:INSIDE MACY'S
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1347
Practice Address - Country:US
Practice Address - Phone:408-274-2007
Practice Address - Fax:408-274-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty