MEDICARE: PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1871723015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3855 BROAD ST STE B
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7109
Country	:	US
Telephone Number	:	805-545-8100
Fax Number	:	805-548-8785

Provider Business Practice Location Address
First Line	:	230 E BETTERAVIA RD STE S
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-7865
Country	:	US
Telephone Number	:	805-925-2645
Fax Number	:	805-925-6556

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	CLIFTON CHAD BAZHAW
Credential	:
Telephone Number	:	214-893-0471

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	02/10/2026

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