Provider Demographics
NPI:1063542777
Name:NORTHERN CALIFORNIA CORNEA ASSOCIATES.INC.
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA CORNEA ASSOCIATES.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:VASTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-444-0603
Mailing Address - Street 1:491 30TH ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3235
Mailing Address - Country:US
Mailing Address - Phone:510-444-0603
Mailing Address - Fax:510-444-6046
Practice Address - Street 1:491 30TH ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3052
Practice Address - Country:US
Practice Address - Phone:510-444-0603
Practice Address - Fax:510-444-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5762152W00000X
CAOPT9734152W00000X
CAG39000207W00000X
CAG17966207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40237Medicare UPIN
CAU42342Medicare UPIN
CAT10110Medicare UPIN
CAA47665Medicare UPIN