Healthcare Provider Details

I. General information

NPI: 1588203988
Provider Name (Legal Business Name): HIGH DESERT EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 KAMANA ROAD
APPLE VALLEY CA
92307-9230
US

IV. Provider business mailing address

555 N 13TH AVE
UPLAND CA
91786-4904
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-0618
  • Fax:
Mailing address:
  • Phone: 92-772-4209
  • Fax: 909-206-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLIFTON CHAD BAZHAW
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 214-893-0471