Provider Demographics
NPI:1215034335
Name:BLACHARSKI, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:BLACHARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41900 WINCHESTER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3403
Mailing Address - Country:US
Mailing Address - Phone:951-679-0400
Mailing Address - Fax:951-672-6667
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-679-0400
Practice Address - Fax:951-672-6667
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44451174400000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G444510Medicaid
CAA40654Medicare UPIN
CA00G444512Medicare ID - Type Unspecified