Provider Demographics
NPI:1083757322
Name:CALIFORNIA RETINA CONSULTANTS
Entity Type:Organization
Organization Name:CALIFORNIA RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-325-4393
Mailing Address - Street 1:525 E MICHELTORENA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2254
Mailing Address - Country:US
Mailing Address - Phone:805-963-1648
Mailing Address - Fax:805-965-5214
Practice Address - Street 1:5555 BUSINESS PARK S STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1678
Practice Address - Country:US
Practice Address - Phone:661-325-4393
Practice Address - Fax:661-322-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091152Medicaid
CAZZZ05252ZOtherBLUE SHIELD GROUP #
CAGR0091152Medicaid
CG5822Medicare PIN