MEDICARE: PACIFIC EYE SPECIALISTS, A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G53132	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578588489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC EYE SPECIALISTS, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1850 SULLIVAN AVE
Second Line	:	SUITE 540
City	:	DALY CITY
State	:	CA
Zip	:	94015-2221
Country	:	US
Telephone Number	:	650-755-6900
Fax Number	:	650-755-2107

Provider Business Practice Location Address
First Line	:	1850 SULLIVAN AVE
Second Line	:	SUITE 540
City	:	DALY CITY
State	:	CA
Zip	:	94015-2215
Country	:	US
Telephone Number	:	650-755-6900
Fax Number	:	650-755-2107

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL HEE
Credential	:	MD
Telephone Number	:	650-755-6900

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/27/2024

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