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General NPI Number Information
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NPI Number | 1790384303
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Entity Type | Organization
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Legal Business Name | ABROMS DOUGHERTY VISION ASC LLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 4472 BROAD ST STE 150
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7990
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Country | US
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Telephone | 805-548-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 4472 BROAD ST STE 150
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7990
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Country | US
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Telephone | 805-548-1051
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Fax |
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | CLIFTON BAZHAW
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Credential |
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Telephone | 214-893-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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