# WALNUT CREEK EYE MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659067155
- **Authorized official:** LEVON DJENDEREDJIAN MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (925) 935-8820

## Contact information

- **Practice address:** 1855 SAN MIGUEL DR STE 28, WALNUT CREEK, CA 94596-5298
- **Practice address phone:** (925) 935-8820
- **Practice address fax:** (925) 935-9542
- **Mailing address:** 1855 SAN MIGUEL DR STE 28, WALNUT CREEK, CA 94596-5298
- **Mailing address phone:** (925) 935-8820
- **Mailing address fax:** (925) 935-9542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 09/08/2023