MEDICARE: CLEAR VISION OUT PATIENT RECOVERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1356719777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR VISION OUT PATIENT RECOVERY CENTER

Provider Business Mailing Address
First Line	:	6886 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2843
Country	:	US
Telephone Number	:	951-313-7403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6886 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2843
Country	:	US
Telephone Number	:	951-313-7403
Fax Number	:

Authorized Official
Title or Position	:	PHYSCIAN
Name	:	DR. MICHAEL F BISHARA
Credential	:	MD
Telephone Number	:	951-313-7403

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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