MEDICARE: ASSOCIATED EYE SPECIALISTS MEDICAL GROUP INC

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	G059821	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457461204	OTHER	CA	NPI

General Provider Information

NPI Number	:	1932396421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED EYE SPECIALISTS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2939 LOMITA RD
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3317
Country	:	US
Telephone Number	:	805-729-3575
Fax Number	:	805-563-0883

Provider Business Practice Location Address
First Line	:	515 E MICHELTORENA ST STE D
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-4224
Country	:	US
Telephone Number	:	805-963-4272
Fax Number	:	805-563-0883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT WILLIAM POULIN
Credential	:	M.D.
Telephone Number	:	805-729-3575

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/18/2025

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