Provider Demographics
NPI:1487608071
Name:SAN BERNARDINO EYE SURGERY CENTER LLC
Entity type:Organization
Organization Name:SAN BERNARDINO EYE SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-246-8769
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:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00266687Medicare PIN
CAZZZ98553ZMedicare PIN