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NPI Code Detail

MEDICARE: SAN DIEGO EYECOR, LLC

MEDICARE: SAN DIEGO EYECOR, LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1922027176
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN DIEGO EYECOR, LLC
Provider Business Mailing Address
First Line : 3939 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-3002
Country : US
Telephone Number : 800-765-2737
Fax Number : 619-291-6577
Provider Business Practice Location Address
First Line : 3939 3RD AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-3002
Country : US
Telephone Number : 619-296-8525
Fax Number : 619-692-0229
Authorized Official
Title or Position : CHIEF REVINUE OFFICER
Name : CLIFTON CHAD BAZHAW
Credential :
Telephone Number : 214-893-0471
Provider Enumeration Date : 07/19/2006
Last Update Date : 03/02/2026

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Directions to “SAN DIEGO EYECOR, LLC ” Practice Location

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