MEDICARE: LIMBERG EYE SURGERY A 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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952459265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMBERG EYE SURGERY A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1270 PEACH ST
Second Line	:	SUITE 100
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2856
Country	:	US
Telephone Number	:	805-541-1342
Fax Number	:	805-541-5836

Provider Business Practice Location Address
First Line	:	1270 PEACH ST
Second Line	:	SUITE 100
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2856
Country	:	US
Telephone Number	:	805-541-1342
Fax Number	:	805-541-5836

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL B LIMBERG
Credential	:	MD
Telephone Number	:	805-541-1342

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	05/31/2016

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Directions to “LIMBERG EYE SURGERY A MEDICAL CORPORATION ” Practice Location

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