Provider Demographics
NPI:1720038458
Name:POLINER, LON SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:SCOTT
Last Name:POLINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12630 MONTE VISTA RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2526
Mailing Address - Country:US
Mailing Address - Phone:858-451-1911
Mailing Address - Fax:858-451-0566
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE #104
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2526
Practice Address - Country:US
Practice Address - Phone:858-451-1911
Practice Address - Fax:858-451-0566
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60369207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180005390OtherRAILROAD MEDICARE-POWAY
CA180016914OtherRAILROAD MDICARE-LA JOLLA
CA00G603690Medicaid
CA180016914OtherRAILROAD MDICARE-LA JOLLA
CA180005390OtherRAILROAD MEDICARE-POWAY