Provider Demographics
NPI:1215122486
Name:DEBORAH DELEON
Entity type:Organization
Organization Name:DEBORAH DELEON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-530-2330
Mailing Address - Street 1:3714 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1330
Mailing Address - Country:US
Mailing Address - Phone:510-530-2330
Mailing Address - Fax:510-530-4947
Practice Address - Street 1:3714 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1330
Practice Address - Country:US
Practice Address - Phone:510-530-2330
Practice Address - Fax:510-530-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11046T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty