EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC. (NPI# 1790965341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790965341 |
| Entity Type | Organization |
| Organization Name | EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC. |
| Other Organization Name | EAST BAY RETINA CONSULTANTS, INC. |
| Practice Address |
3300 Telegraph Ave. Oakland CA 94609-3028 |
| Practice Telephone | 5104441600 |
| Practice Fax Number | 5104445117 |
| Mailing Telephone | 5104441600 |
| Mailing Fax Number | 5104445117 |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2015-12-28 |
| Authorized Official Name | SOON T. LEE (CORPORATE VICE PRESIDENT) |
| Authorized Official Telephone | 5104441600 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | G57682 | CA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| East Bay Retina Consultants, Inc. | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679855076 | East Bay Retina Consultants A Medical Group, Inc. | Ophthalmology | 5924 Stoneridge Dr, Suite 201, Pleasanton, CA 94588-2887 | 2011-09-13 |
| 1124319959 | East Bay Retina Consultants A Medical Group, Inc. | Ophthalmology | 1401 Willow Pass Rd, Suite 120, Concord, CA 94520-7982 | 2011-04-27 |
| 1578509667 | East Bay Retina Consultants A Medical Group, Inc. | Ophthalmology | 5401 Norris Canyon Rd, Suite 200, San Ramon, CA 94583-5409 | 2006-06-20 |
| 1487690574 | East Bay Retina Consultants A Medical Group, Inc. | Ophthalmology | 1860 Mowry Ave, Suite 308, Fremont, CA 94538-1730 | 2006-06-20 |
| 1326031907 | East Bay Retina Consultants A Medical Group, Inc. | Ophthalmology | 3300 Webster St, Suite 1110, Oakland, CA 94609-3117 | 2005-08-29 |
| Street Address |
3300 TELEGRAPH AVE. |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114299179 | Richard Arden Deutsche | Ophthalmology | 121 Hazel Lane, Oakland, CA 94611 | 2012-02-06 |
| 1528344751 | Daniel John Kim | Ophthalmology | 6020 Thornhill Dr, Oakland, CA 94611-2150 | 2011-11-02 |
| 1053612333 | E James Langham Md Inc | Ophthalmology | 491 30th Street, #201, Oakland, CA 94609-3235 | 2010-11-03 |
| 1669782124 | Jennifer Edith De Niro | Ophthalmology | 491 30th St Ste 201, Oakland, CA 94609-3235 | 2010-10-19 |
| 1285941195 | Samuel Reiter | Ophthalmology | 3772 Howe St Fl 3, Oakland, CA 94611 | 2010-09-13 |
| 1639303118 | Iryna Anatoliyevna Falkenstein | Ophthalmology | 491 30th St Ste 103, Oakland, CA 94609 | 2009-05-12 |
| 1255438800 | Selim Taylan Koseoglu | Ophthalmology | 5275 Claremont Ave, Oakland, CA 94618-1032 | 2006-09-17 |
| 1023129095 | Richard Hoo Lee Jr. | Ophthalmology | 491 30th St Suite #201, Oakland, CA 94609 | 2006-08-31 |
| 1346274024 | Jane V Loman | Ophthalmology | 80 Grand Ave Ste 700, Oakland, CA 94612-3744 | 2006-07-10 |
| 1033178876 | Amater Zeale Traylor Jr. | Ophthalmology | 5682 Adeline Street, Oakland, CA 94608-2804 | 2006-03-21 |
| Find all providers in OAKLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.