Provider Demographics
NPI:1659478600
Name:INLAND VALLEY RETINA MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:INLAND VALLEY RETINA MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACHARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-679-0400
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 1:41900 WINCHESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3403
Practice Address - Country:US
Practice Address - Phone:951-679-0400
Practice Address - Fax:951-672-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090220Medicaid
ZZZ01731ZMedicare ID - Type Unspecified
CAZZZ21271ZMedicare ID - Type Unspecified