Provider Demographics
NPI:1831494426
Name:CALIFORNIA EYE PROFESSIONALS MEDICAL GROUP INC PC
Entity Type:Organization
Organization Name:CALIFORNIA EYE PROFESSIONALS MEDICAL GROUP INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-301-8888
Mailing Address - Street 1:29826 HAUN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6546
Mailing Address - Country:US
Mailing Address - Phone:951-301-8888
Mailing Address - Fax:951-301-4137
Practice Address - Street 1:29826 HAUN RD
Practice Address - Street 2:STE 100
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6546
Practice Address - Country:US
Practice Address - Phone:951-301-8888
Practice Address - Fax:951-301-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty