Healthcare Provider Details

I. General information

NPI: 1891086294
Provider Name (Legal Business Name): CALIFORNIA RETINA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GATEWAY CENTER DR STE B
PASO ROBLES CA
93446-3752
US

IV. Provider business mailing address

525 E MICHELTORENA ST SUITE A
SANTA BARBARA CA
93103-2254
US

V. Phone/Fax

Practice location:
  • Phone: 805-237-1610
  • Fax: 805-880-5915
Mailing address:
  • Phone: 805-963-1648
  • Fax: 805-965-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT AVERY
Title or Position: CEO
Credential: MD
Phone: 805-963-1648