MEDICARE: INLAND EYE SPECIALISTS A MEDICAL CORP

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

General Provider Information

NPI Number	:	1841705183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND EYE SPECIALISTS A MEDICAL CORP

Provider Business Mailing Address
First Line	:	PO BOX 845426
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-5426
Country	:	US
Telephone Number	:	858-487-7900
Fax Number	:	858-487-1896

Provider Business Practice Location Address
First Line	:	16615 DOVE CANYON RD STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3441
Country	:	US
Telephone Number	:	858-487-7900
Fax Number	:	858-487-1896

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MR. GEORGE NEAL
Credential	:
Telephone Number	:	844-377-6468

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	03/12/2020

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