Healthcare Provider Details

I. General information

NPI: 1518615947
Provider Name (Legal Business Name): INLAND EYE SPECIALISTS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 N. HIGHLAND SPRINGS AVE. STE. 300
BEAUMONT CA
92223
US

IV. Provider business mailing address

PO BOX 845426
LOS ANGELES CA
90084-5426
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-4749
  • Fax: 951-845-8625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 469-214-0144