Provider Demographics
NPI:1154382026
Name:GRONDONA,JR, CARL ALFRED (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ALFRED
Last Name:GRONDONA,JR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2206
Mailing Address - Country:US
Mailing Address - Phone:510-893-5566
Mailing Address - Fax:510-893-3921
Practice Address - Street 1:1960 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2206
Practice Address - Country:US
Practice Address - Phone:510-893-5566
Practice Address - Fax:510-893-3921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4089T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATO9558Medicare UPIN