Provider Demographics
NPI:1043221922
Name:CHILDREN'S EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:CHILDREN'S EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-931-9675
Mailing Address - Street 1:1246 E ARROW HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4955
Mailing Address - Country:US
Mailing Address - Phone:909-931-9675
Mailing Address - Fax:909-931-3239
Practice Address - Street 1:1246 E ARROW HWY
Practice Address - Street 2:SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4955
Practice Address - Country:US
Practice Address - Phone:909-931-9675
Practice Address - Fax:909-931-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0096060Medicaid
CAGR0096061Medicaid
CAGR0096062Medicaid
CAGR0096061Medicaid