Healthcare Provider Details

I. General information

NPI: 1962422709
Provider Name (Legal Business Name): PACIFIC EYE INSTITUTE, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 13TH AVE
UPLAND CA
91786-4904
US

IV. Provider business mailing address

555 N 13TH AVE
UPLAND CA
91786-4904
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-8846
  • Fax: 909-949-3967
Mailing address:
  • Phone: 909-982-8846
  • Fax: 909-949-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANTE CERVANTES
Title or Position: OPERATIONS SUPPORT
Credential:
Phone: 909-277-2420