Provider Demographics
NPI:1386848216
Name:ROBERT B PENDLETON MD PHD INC
Entity Type:Organization
Organization Name:ROBERT B PENDLETON MD PHD INC
Other - Org Name:PENDLETON EYE CENTER A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:760-758-2008
Mailing Address - Street 1:3637 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4522
Mailing Address - Country:US
Mailing Address - Phone:760-758-2008
Mailing Address - Fax:760-758-2004
Practice Address - Street 1:3637 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4522
Practice Address - Country:US
Practice Address - Phone:760-758-2008
Practice Address - Fax:760-758-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83487207W00000X, 261Q00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G834870Medicaid
CAF84675Medicare UPIN
CAW20885Medicare PIN
CA00G834870Medicaid
CA5092410001Medicare NSC