Provider Demographics
NPI:1619092145
Name:DIANE C ALBRACHT M D INC
Entity Type:Organization
Organization Name:DIANE C ALBRACHT M D INC
Other - Org Name:CASTRO VALLEY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALBRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-538-5252
Mailing Address - Street 1:21675 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6431
Mailing Address - Country:US
Mailing Address - Phone:510-538-5252
Mailing Address - Fax:510-538-3884
Practice Address - Street 1:21675 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6431
Practice Address - Country:US
Practice Address - Phone:510-538-5252
Practice Address - Fax:510-538-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10136T152W00000X
156FX1100X, 156FX1800X
CAA25235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048700Medicaid
CAGR0048700Medicaid
CA=========OtherTAX ID
CAGR0048700Medicaid