Provider Demographics
NPI:1356719777
Name:CLEAR VISION OUT PATIENT RECOVERY CENTER
Entity type:Organization
Organization Name:CLEAR VISION OUT PATIENT RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-313-7403
Mailing Address - Street 1:6886 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2843
Mailing Address - Country:US
Mailing Address - Phone:951-313-7403
Mailing Address - Fax:
Practice Address - Street 1:6886 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2843
Practice Address - Country:US
Practice Address - Phone:951-313-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEAR VISION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29674Medicare UPIN