Provider Demographics
NPI:1598898249
Name:DR. ZHUBLAWAR OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DR. ZHUBLAWAR OPTOMETRIC CORPORATION
Other - Org Name:THE OPTOMETRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUJDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHUBLAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIC DOCTOR
Authorized Official - Phone:510-581-1430
Mailing Address - Street 1:1575 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3017
Mailing Address - Country:US
Mailing Address - Phone:510-581-1430
Mailing Address - Fax:510-581-7368
Practice Address - Street 1:1575 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3017
Practice Address - Country:US
Practice Address - Phone:510-581-1430
Practice Address - Fax:510-581-7368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. ZHUBLAWAR OPTOMETRIC CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7311T152W00000X
CAOPT12886TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD00731105Medicaid
CAZZZ06729ZMedicare PIN
CASD00731105Medicaid