Provider Demographics
NPI:1497740872
Name:SHASTA EYE SURGEONS INC
Entity Type:Organization
Organization Name:SHASTA EYE SURGEONS INC
Other - Org Name:SURGERY CENTER OF NORTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-377-6468
Mailing Address - Street 1:950 BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0827
Mailing Address - Country:US
Mailing Address - Phone:530-223-2500
Mailing Address - Fax:530-241-1408
Practice Address - Street 1:950 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0827
Practice Address - Country:US
Practice Address - Phone:530-223-2500
Practice Address - Fax:530-241-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA051087261QA1903X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
490004349OtherRR MEDICARE
CASUR01087HMedicaid
ZZZ16213ZMedicare ID - Type Unspecified