Provider Demographics
NPI:1477854123
Name:ROBERT S. HERRICK M.D. INC
Entity Type:Organization
Organization Name:ROBERT S. HERRICK M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-820-4051
Mailing Address - Street 1:882 W RIALTO AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5658
Mailing Address - Country:US
Mailing Address - Phone:909-820-4051
Mailing Address - Fax:909-820-4053
Practice Address - Street 1:882 W RIALTO AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5658
Practice Address - Country:US
Practice Address - Phone:909-820-4051
Practice Address - Fax:909-820-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24395207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC24395Medicaid
CAC24395Medicaid