Provider Demographics
NPI:1871539130
Name:MACIAS, EDUARDO PEDRO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:PEDRO
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18066 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8503
Mailing Address - Country:US
Mailing Address - Phone:909-427-8900
Mailing Address - Fax:951-359-0550
Practice Address - Street 1:18066 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8503
Practice Address - Country:US
Practice Address - Phone:909-427-8900
Practice Address - Fax:951-359-0550
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A867390Medicaid
CAA86739Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CAI13389Medicare UPIN