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Organization
DELTA EYE MEDICAL GROUP, INC.
Active
Organization
DELTA EYE MEDICAL GROUP, INC.
Active
Parent organization
DELTA EYE MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DELTA EYE MEDICAL GROUP, INC.
Authorized official
MS. LAURIE K SMITH (CORPORATE CONTROLLER)
(209) 334-5886
Entity
Organization
Contact information
Practice address
521 S HAM LN, SUITE A, LODI, CA 95242-3528
(209) 334-5886
(209) 334-5281
Mailing address
521 S HAM LN, SUITE A, LODI, CA 95242-3528
(209) 334-5886
(209) 334-5281
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD8211
RAILROAD MEDICARE
CA
05
—
GR0008460
—
CA
Enumeration date
10/09/2007
Last updated
07/14/2023
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