# EYE SPECIALTIES MEDICAL GROUP INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eye Specialties Medical Group Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568030260
- **Authorized official:** MS. DEBORAH H TAFOYA (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (510) 881-8823

## Contact information

- **Practice address:** 20046 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5304
- **Practice address phone:** (510) 881-8823
- **Practice address fax:** (510) 881-2134
- **Mailing address:** 20046 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5304
- **Mailing address phone:** (510) 881-8823
- **Mailing address fax:** (510) 881-2134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2021
- **Last updated:** 10/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007110001 | — | CA |