Active NPI
Coachella Valley Retina
- Ophthalmology Physician
- Rancho Mirage, CA
National Provider Identifier
1871928945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- A64900
- Legal business name
- COACHELLA VALLEY RETINA
- Practice address
- 72301 Country Club Dr Ste 108
Rancho Mirage, CA 92270-8007 - Phone
- (760) 895-1993
- Fax
- (760) 862-1992
- NPI assigned
- Sep 9, 2013
- Last updated
- Oct 18, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Camille Harrison, MD
- Title
- President
- Phone
- (760) 464-8244
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | A64900 | CA | Primary |
Addresses
Primary practice location
72301 Country Club Dr Ste 108
Rancho Mirage, CA 92270-8007
Mailing address
72-301 Country Club Drive , Suite 108
Rancho Mirage, CA 92270
Phone (760) 895-1993
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A649000 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- Coachella Valley Retina
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ophthalmology Physician
- Rancho Mirage, CA
- NPI 1376970228
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Ophthalmology Physician
- Rancho Mirage, CA
- NPI 1366520140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378684800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1382054400000",
"number": "1871928945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72-301 COUNTRY CLUB DRIVE , SUITE 108",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "92270",
"telephone_number": "760-895-1993",
"fax_number": "760-862-1992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72301 COUNTRY CLUB DR STE 108",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922708007",
"telephone_number": "760-895-1993",
"fax_number": "760-862-1992"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COACHELLA VALLEY RETINA",
"organizational_subpart": "NO",
"enumeration_date": "2013-09-09",
"last_updated": "2013-10-18",
"status": "A",
"authorized_official_last_name": "HARRISON",
"authorized_official_first_name": "CAMILLE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "760-464-8244",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "A64900",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A649000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rancho Mirage, CA
- Coachella Valley Direct Primary Care
- Coachella Valley Eye Institute PC
- Coachella Valley Pathology
- Coachella Valley Pharmacy Inc (Coachella Valley LTC)
- Coachella Valley Retina
- Coachellamed a Professional Corporation (Coachellamed)
- Eliane Fani Coffler
- Randy E Cohen, M.D.
- Morton James Cohn, M.D.
- Alan S Coit, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.