Healthcare Provider Details

I. General information

NPI: 1831494426
Provider Name (Legal Business Name): CALIFORNIA EYE PROFESSIONALS MEDICAL GROUP INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29826 HAUN RD STE 100
MENIFEE CA
92586-6546
US

IV. Provider business mailing address

29826 HAUN RD STE 100
MENIFEE CA
92586-6546
US

V. Phone/Fax

Practice location:
  • Phone: 951-301-8888
  • Fax: 951-301-4137
Mailing address:
  • Phone: 951-301-8888
  • Fax: 951-301-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG50680
License Number StateCA

VIII. Authorized Official

Name: WILLIAM BLASE
Title or Position: OWNER
Credential: MD
Phone: 951-301-8888