Provider Demographics
NPI:1306966270
Name:HAYWARD OPTOMETRY, INC.
Entity type:Organization
Organization Name:HAYWARD OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-733-3105
Mailing Address - Street 1:865 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5107
Mailing Address - Country:US
Mailing Address - Phone:510-733-3105
Mailing Address - Fax:
Practice Address - Street 1:865 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5107
Practice Address - Country:US
Practice Address - Phone:510-733-3105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12052T261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120520Medicaid
CAZZZ07312ZMedicare PIN
CAU71237Medicare UPIN