Provider Demographics
NPI:1780045658
Name:ETWARU EYE CENTER
Entity type:Organization
Organization Name:ETWARU EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUPTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETWARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-676-8365
Mailing Address - Street 1:395 CIVIC DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1979
Mailing Address - Country:US
Mailing Address - Phone:925-676-8365
Mailing Address - Fax:925-954-6939
Practice Address - Street 1:395 CIVIC DR
Practice Address - Street 2:SUITE G
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1979
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:925-954-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty