Healthcare Provider Details

I. General information

NPI: 1134399462
Provider Name (Legal Business Name): CALIFORNIA RETINA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAS TABLAS RD SUITE C
TEMPLETON CA
93465-9729
US

IV. Provider business mailing address

515 E MICHELTORENA ST SUITE C
SANTA BARBARA CA
93103-2257
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5450
  • Fax:
Mailing address:
  • Phone: 805-963-1648
  • Fax:

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 LOGAN AVERY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 805-963-1648