Provider Demographics
NPI:1114950086
Name:INLAND EYE SPECIALISTS A MEDICAL CORP
Entity Type:Organization
Organization Name:INLAND EYE SPECIALISTS A MEDICAL CORP
Other - Org Name:INLAND EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-377-6468
Mailing Address - Street 1:PO BOX 845426
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5426
Mailing Address - Country:US
Mailing Address - Phone:951-303-0575
Mailing Address - Fax:951-266-5302
Practice Address - Street 1:31950 TEMECULA PKWY
Practice Address - Street 2:SUITE B7
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5801
Practice Address - Country:US
Practice Address - Phone:951-303-0575
Practice Address - Fax:951-266-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
CA016994261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD003102Medicaid
CAGR0044191Medicaid
CA0764520004Medicare NSC
CAGR0044191Medicaid