# PACIFIC EYE INSTITUTE A MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Eye Institute Ambulatory Surgery CTR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407932619
- **Authorized official:** RICHMOND ROESKE (PHYSICIAN/OWNER)
- **Authorized official phone:** (800) 345-8979

## Contact information

- **Practice address:** 555 N 13TH AVE, UPLAND, CA 91786-4904
- **Practice address phone:** (909) 982-8846
- **Practice address fax:** (909) 931-0791
- **Mailing address:** 555 N 13TH AVE, UPLAND, CA 91786-4904
- **Mailing address phone:** (909) 982-8846
- **Mailing address fax:** (909) 931-0791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 240000525 | CA | Yes |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 02/14/2025