Provider Demographics
NPI:1134399462
Name:CALIFORNIA RETINA CONSULTANTS
Entity type:Organization
Organization Name:CALIFORNIA RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-963-1648
Mailing Address - Street 1:515 E MICHELTORENA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2257
Mailing Address - Country:US
Mailing Address - Phone:805-963-1648
Mailing Address - Fax:
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE C
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty