Healthcare Provider Details

I. General information

NPI: 1205847746
Provider Name (Legal Business Name): GOLDEN STATE EYE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 PHYSICIANS BLVD BUILDING D SUITE 205
BAKERSFIELD CA
93301-5840
US

IV. Provider business mailing address

6000 PHYSICIANS BLVD BLDG D
BAKERSFIELD CA
93301-5840
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-4499
  • Fax: 661-327-4381
Mailing address:
  • Phone: 661-327-4499
  • Fax: 661-327-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13086T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG30637
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KHALED A TAWANSY
Title or Position: OWNER
Credential: M.D
Phone: 661-327-4499