Provider Demographics
NPI:1659067155
Name:WALNUT CREEK EYE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:WALNUT CREEK EYE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:DJENDEREDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-935-8820
Mailing Address - Street 1:1855 SAN MIGUEL DR STE 28
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5298
Mailing Address - Country:US
Mailing Address - Phone:925-935-8820
Mailing Address - Fax:925-935-9542
Practice Address - Street 1:1855 SAN MIGUEL DR STE 28
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5298
Practice Address - Country:US
Practice Address - Phone:925-935-8820
Practice Address - Fax:925-935-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty