Pacific Eye Institute a Medical Group Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

PACIFIC EYE INSTITUTE A MEDICAL GROUP INC

Practice address

16177 Kamana Rd
Apple Valley, CA 92307-1377

Phone

(800) 345-8979

NPI assigned

Apr 18, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richmond Roeske, MD

Title

Owner

Phone

(909) 277-2420

Specialties & licenses 1

Addresses

Tax ID family

Pacific Eye Institute a Med2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pacific Eye Institute, a Medical Group, Inc.

  • Ophthalmology Physician
  • Upland, CA
  • NPI 1962422709
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1316680200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N 13TH AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864904",
            "telephone_number": "909-277-2420",
            "fax_number": "909-206-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16177 KAMANA RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071377",
            "telephone_number": "800-345-8979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYE INSTITUTE A MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-18",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "ROESKE",
        "authorized_official_first_name": "RICHMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-277-2420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desirae M Pacheco
• Dora Pacheco
• Matthew Lopez Pacheco
• Pacific Clinics
• Pacific Clinics
• Pacifica Valley Crest LP
• Eric Andrews Packard, OTR/L
• Chelsea Nicole Tanilon Paclibar, DDS
• Natalie Padilla, B.A.
• Vianca Padilla

• Ophthalmology Physician in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.