Healthcare Provider Details

I. General information

NPI: 1497740872
Provider Name (Legal Business Name): SHASTA EYE SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BUTTE ST
REDDING CA
96001-0827
US

IV. Provider business mailing address

950 BUTTE ST
REDDING CA
96001-0827
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2500
  • Fax: 530-241-1408
Mailing address:
  • Phone: 530-223-2500
  • Fax: 530-241-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number051087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number051087
License Number StateCA

VIII. Authorized Official

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