Provider Demographics
NPI:1689688095
Name:MOSTARDI, BARBARA K (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:K
Last Name:MOSTARDI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 BRENTWOOD BLVD.
Mailing Address - Street 2:# D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513
Mailing Address - Country:US
Mailing Address - Phone:925-634-0303
Mailing Address - Fax:925-634-0338
Practice Address - Street 1:8440 BRENTWOOD BLVD.
Practice Address - Street 2:# D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-634-0303
Practice Address - Fax:925-634-0338
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8813T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8813TMedicare UPIN