Provider Demographics
NPI:1619991080
Name:FREMONT OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:FREMONT OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-744-2010
Mailing Address - Street 1:39355 CALIFORNIA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1447
Mailing Address - Country:US
Mailing Address - Phone:510-744-2010
Mailing Address - Fax:510-744-2015
Practice Address - Street 1:39355 CALIFORNIA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1447
Practice Address - Country:US
Practice Address - Phone:510-744-2010
Practice Address - Fax:510-744-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4655T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0213010001Medicare NSC
CAZZZ15747ZMedicare PIN
CAGR0022890Medicaid