Healthcare Provider Details

I. General information

NPI: 1902436348
Provider Name (Legal Business Name): DLV VISION ASC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WILLOW LN STE 118
THOUSAND OAKS CA
91361-4986
US

IV. Provider business mailing address

4353 PARK TERRACE DR STE 150
WESTLAKE VILLAGE CA
91361-4639
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-3914
  • Fax: 818-707-7668
Mailing address:
  • Phone: 805-987-5300
  • Fax: 818-707-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

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