Organization
PACIFIC EYE INSTITUTE A MEDICAL GROUP INC
Active
Other names
Pacific Eye Institute Ambulatory Surgery CTR
Organization subpart
No
Provider details
NPI number
Authorized official
RICHMOND ROESKE (PHYSICIAN/OWNER)
(800) 345-8979
Entity
Organization
Contact information
Practice address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 982-8846
(909) 931-0791
Mailing address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 982-8846
(909) 931-0791
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
240000525
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR51061F
—
CA
Enumeration date
10/31/2006
Last updated
02/14/2025
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