Healthcare Provider Details

I. General information

NPI: 1821952318
Provider Name (Legal Business Name): PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E OCEAN AVE STE 7
LOMPOC CA
93436-2501
US

IV. Provider business mailing address

3855 BROAD ST STE B
SAN LUIS OBISPO CA
93401-7109
US

V. Phone/Fax

Practice location:
  • Phone: 805-545-8100
  • Fax: 805-548-8785
Mailing address:
  • Phone: 805-545-8100
  • Fax: 805-548-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CLIFTON CHAD BAZHAW
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 469-270-6658