MEDICARE: RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR

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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1477206365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP, A CALIFORNIA MEDICAL PAR

Provider Business Mailing Address
First Line	:	288 N SANTA ANITA AVE STE 402
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3183
Country	:	US
Telephone Number	:	800-898-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	7339 EL CAJON BLVD STE A
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7435
Country	:	US
Telephone Number	:	619-722-8460
Fax Number	:	619-722-8465

Authorized Official
Title or Position	:	PROVIDER RELATIONS COORDINATOR
Name	:	JULIA MILAN
Credential	:
Telephone Number	:	805-418-5532

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	02/16/2026

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