Organization
RIVERSIDE EYE SPECIALISTS MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAY ROGERS GLENDRANGE M.D. (SECRETARY/OWNER)
(951) 686-4911
Entity
Organization
Contact information
Practice address
4605 BROCKTON AVE, SUITE 100, RIVERSIDE, CA 92506-0106
(951) 686-4911
(951) 686-9409
Mailing address
4605 BROCKTON AVE, SUITE 100, RIVERSIDE, CA 92506-0106
(951) 686-4911
(951) 686-9409
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD8734
PALMETTO, GBA
CA
05
—
GR0079980
—
CA
Enumeration date
04/03/2006
Last updated
11/26/2013
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