Provider Demographics
NPI:1174557805
Name:BAY AREA RETINA ASSOCIATES, MEDICAL GROUP
Entity type:Organization
Organization Name:BAY AREA RETINA ASSOCIATES, MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-818-2399
Mailing Address - Street 1:365 LENNON LN STE 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-943-6800
Mailing Address - Fax:925-943-6880
Practice Address - Street 1:365 LENNON LN STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5915
Practice Address - Country:US
Practice Address - Phone:925-943-6800
Practice Address - Fax:925-943-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0030671Medicaid
CAGR0030670Medicaid
CAGR0030671Medicaid
ZZZ19342ZMedicare ID - Type UnspecifiedMEDICARE ID# OAKLAND
ZZZ29803ZMedicare ID - Type UnspecifiedMEDICARE ID# ANTIOCH
CAGR0030670Medicaid
ZZZ19345ZMedicare ID - Type UnspecifiedMEDICARE ID# VALLEJO
CAZZZ19343ZMedicare ID - Type UnspecifiedNHIC LOCATION ID #