Organization
CALIFORNIA RETINA CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT L AVERY MD (CEO)
(805) 963-1648
Entity
Organization
Contact information
Practice address
1510 E MAIN ST, SUITE 103, SANTA MARIA, CA 93454-4825
(805) 922-2068
(805) 880-5915
Mailing address
525 E MICHELTORENA ST, SUITE A, SANTA BARBARA, CA 93103-2254
(805) 963-1648
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0091151
—
CA
01
—
ZZZ60752Z
BLUE SHIELD GROUP #
CA
Enumeration date
02/15/2007
Last updated
07/21/2022
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