Provider Demographics
NPI:1386677326
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:90084-9687
Mailing Address - Country:US
Mailing Address - Phone:951-652-4343
Mailing Address - Fax:951-266-5302
Practice Address - Street 1:3953 W. STETSON AVE.
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545
Practice Address - Country:US
Practice Address - Phone:951-652-4343
Practice Address - Fax:951-658-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000263261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01623FMedicaid
CAZZZ97080ZMedicare PIN