Organization
RETINA CONSULTANTS SAN DIEGO INC
Active
Other names
Retina Consultants San Diego Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JOCELIN ING (PRACTICE ADMINISTRATOR)
(858) 500-7815
Entity
Organization
Contact information
Practice address
12630 MONTE VISTA RD, SUITE 104, POWAY, CA 92064-2526
(858) 451-1911
(858) 451-0566
Mailing address
12630 MONTE VISTA RD, SUITE 104, POWAY, CA 92064-2526
(858) 451-1911
(858) 451-0566
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA1466
MEDICARE RAILROAD
CA
05
—
GR0045281
—
CA
01
—
ZZZ30299Z
BLUE SHIELD
CA
Enumeration date
05/12/2006
Last updated
02/06/2024
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