Healthcare Provider Details

I. General information

NPI: 1942235643
Provider Name (Legal Business Name): INLAND EYE SPECIALISTS A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25395 HANCOCK AVE SUITE 100
MURRIETA CA
92562-9054
US

IV. Provider business mailing address

PO BOX 845426
LOS ANGELES CA
90084-5426
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-5388
  • Fax: 951-266-5302
Mailing address:
  • Phone: 951-696-5388
  • 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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
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: 469-214-0144