PACIFIC EYE INSTITUTE, A MEDICAL GROUP, INC.
Complete NPI Record 1962422709
Ophthalmology in Upland, CA
Active since July 21, 2006CLIA 05D2055342 · Waiver
Complete NPI Dataset
This page contains the complete raw NPPES record for Pacific Eye Institute, A Medical Group, Inc. (NPI 1962422709), an ophthalmology organization in Upland, CA. All 38 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1962422709 Field 1/38
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/38
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/38
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: PACIFIC EYE INSTITUTE, A MEDICAL GROUP, INC. Field 4/38
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 555 N 13TH AVE Field 5/38
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: UPLAND Field 6/38
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CA Field 7/38
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 917864904 Field 8/38
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/38
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 9099828846 Field 10/38
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9099493967 Field 11/38
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 555 N 13TH AVE Field 12/38
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: UPLAND Field 13/38
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CA Field 14/38
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 917864904 Field 15/38
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/38
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9099828846 Field 17/38
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9099493967 Field 18/38
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: CERVANTES Field 21/38
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: DANTE Field 22/38
- The first name of the authorized official.
- Authorized Official Title or Position: MEDICAL STAFF SERVICES SPECIALIST Field 23/38
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9092772420 Field 24/38
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207W00000X Field 25/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 26/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: GR0055503 Field 27/38
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 28/38
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: CA Field 29/38
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 2: GR0055500 Field 30/38
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 05 Field 31/38
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: CA Field 32/38
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 3: GR0055502 Field 33/38
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 3: 05 Field 34/38
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 3: CA Field 35/38
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 36/38
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 37/38
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 22
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
500 E Mountain View St
Location 1/22Barstow, CA 92311-2937 · Phone (800) 645-8979
11959 Mariposa Rd
Location 2/22Hesperia, CA 92345-1696 · Phone (800) 345-8979
930 W Main St
Location 3/22Barstow, CA 92311-2654 · Phone (800) 345-8979 · Fax (909) 949-3967
9834 Genesee Ave Ste 200
Location 4/22LA Jolla, CA 92037-1225 · Phone (858) 457-3050
16177 Kamana Rd
Location 5/22Apple Valley, CA 92307-1377 · Phone (760) 946-0618
9834 Genesee Ave Ste 428
Location 6/22LA Jolla, CA 92037-1264 · Phone (800) 765-2737
8112 Milliken Ave Ste 203
Location 7/22Rancho Cucamonga, CA 91730-7473 · Phone (800) 345-8979
700 W El Norte Pkwy
Location 8/22Escondido, CA 92026-3923 · Phone (800) 765-2737
1900 E Washington St
Location 9/22Colton, CA 92324-4614 · Phone (800) 645-8979
12442 Limonite Ave Unit 200
Location 10/22Eastvale, CA 91752-2467 · Phone (800) 345-8979
6216 Brockton Ave Ste 214
Location 11/22Riverside, CA 92506-2223 · Phone (951) 686-1190
340 S Farrell Dr Bldg 105
Location 12/22Palm Springs, CA 92262-7963 · Phone (760) 327-6225
591 N 13th Ave
Location 13/22Upland, CA 91786-4967 · Phone (800) 345-8979
5330 Carroll Canyon Rd Ste 210
Location 14/22San Diego, CA 92121-3758 · Phone (800) 765-2737
3939 3rd Ave
Location 15/22San Diego, CA 92103-3002 · Phone (858) 450-1010
41877 Enterprise Cir N Ste 110
Location 16/22Temecula, CA 92590-5628 · Phone (800) 345-8979
591 N 13th Ave Ste 3
Location 17/22Upland, CA 91786-4968 · Phone (800) 345-8979
40055 Bob Hope Dr Ste J
Location 18/22Rancho Mirage, CA 92270-3940 · Phone (760) 346-5005
15099 Kamana Rd
Location 19/22Apple Valley, CA 92307-1388 · Phone (800) 345-8979 · Fax (800) 345-8979
3637 Vista Way
Location 20/22Oceanside, CA 92056-4522 · Phone (760) 758-2008
36949 Cook St Ste 101
Location 21/22Palm Desert, CA 92211-6080 · Phone (760) 340-2394
9481 Haven Ave Ste 200
Location 22/22Rancho Cucamonga, CA 91730-5811 · Phone (909) 937-9230
Other Provider Identifiers 3
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
GR0055503 Medicaid
Identifier 1/3State: CA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
GR0055500 Medicaid
Identifier 2/3State: CA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
GR0055502 Medicaid
Identifier 3/3State: CA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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