Healthcare Provider Details

I. General information

NPI: 1649540303
Provider Name (Legal Business Name): INLAND EYE SPECIALISTS A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25460 MEDICAL CENTER DR SUITE 103
MURRIETA CA
92562-5985
US

IV. Provider business mailing address

PO BOX 845426
LOS ANGELES CA
90084-5426
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4575
  • Fax: 951-266-5302
Mailing address:
  • Phone: 951-698-4575
  • Fax: 951-266-5302

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