Healthcare Provider Details

I. General information

NPI: 1669426250
Provider Name (Legal Business Name): INLAND EYE INSTITUTE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E WASHINGTON ST
COLTON CA
92324-4614
US

IV. Provider business mailing address

1900 E WASHINGTON ST
COLTON CA
92324-4614
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-3425
  • Fax: 909-825-6991
Mailing address:
  • Phone: 909-825-3425
  • Fax: 909-825-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER L. BLANTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-825-3425