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General NPI Number Information
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NPI Number | 1871723015
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Entity Type | Organization
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Legal Business Name | PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 230 E BETTERAVIA RD STE S
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City | SANTA MARIA
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State | CA
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Zip | 93454-7865
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Country | US
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Telephone | 805-925-2645
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Fax | 805-925-6556
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Provider Business Mailing Address
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Address Line | 3855 BROAD ST STE B
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7109
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Country | US
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Telephone | 805-545-8100
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Fax | 805-548-8785
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | CLIFTON CHAD BAZHAW
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Credential |
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Telephone | 469-270-6658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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