Provider Demographics
NPI:1144405309
Name:CALIFORNIA RETINA CONSULTANTS
Entity Type:Organization
Organization Name:CALIFORNIA RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-963-1648
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:
Practice Address - Street 1:835 AEROVISTA PL
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8740
Practice Address - Country:US
Practice Address - Phone:805-781-0292
Practice Address - Fax:805-880-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
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