Provider Demographics
NPI:1184812851
Name:DELTA EYE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:DELTA EYE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-478-1797
Mailing Address - Street 1:2160 W GRANT LINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7330
Mailing Address - Country:US
Mailing Address - Phone:209-835-2227
Mailing Address - Fax:
Practice Address - Street 1:2160 W GRANT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7330
Practice Address - Country:US
Practice Address - Phone:209-835-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA EYE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0008462Medicaid
CADE2454OtherRAILROAD MEDICARE
CAZZZ13864ZMedicare PIN
CAGR0008462Medicaid