Provider Demographics
NPI:1992889240
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:OWNER
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:925-947-0888
Mailing Address - Street 1:122 LA CASA VIA
Mailing Address - Street 2:STE 222
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-947-0888
Mailing Address - Fax:925-947-4385
Practice Address - Street 1:122 LA CASA VIA
Practice Address - Street 2:STE 222
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-947-0888
Practice Address - Fax:925-947-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG17966207W00000X
GAG39000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103840Medicaid
CAGSD005430Medicaid
CAGR0103840Medicaid