Healthcare Provider Details

I. General information

NPI: 1386677326
Provider Name (Legal Business Name): INLAND EYE SPECIALISTS A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 W. STETSON AVE.
HEMET CA
92545
US

IV. Provider business mailing address

PO BOX 845426
LOS ANGELES CA
90084-9687
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-4343
  • Fax: 951-658-3953
Mailing address:
  • Phone: 951-652-4343
  • Fax: 951-266-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number250000263
License Number StateCA

VIII. Authorized Official

Name: MR. GEORGE NEAL
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 844-377-6468