Provider Demographics
NPI:1669426250
Name:INLAND EYE INSTITUTE MEDICAL GROUP INC
Entity type:Organization
Organization Name:INLAND EYE INSTITUTE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-825-3425
Mailing Address - Street 1:1900 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4614
Mailing Address - Country:US
Mailing Address - Phone:909-825-3425
Mailing Address - Fax:909-825-6991
Practice Address - Street 1:1900 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4614
Practice Address - Country:US
Practice Address - Phone:909-825-3425
Practice Address - Fax:909-825-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029163Medicaid
CACP5178Medicare PIN
CAEK101AMedicare PIN
CAGR0029163Medicaid