Provider Demographics
NPI:1073979670
Name:LENS MASTERS OF ATASCADERO INC
Entity Type:Organization
Organization Name:LENS MASTERS OF ATASCADERO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-466-6939
Mailing Address - Street 1:PO BOX 5257
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-5257
Mailing Address - Country:US
Mailing Address - Phone:805-454-7881
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:8105 MORRO RD STE A
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3911
Practice Address - Country:US
Practice Address - Phone:805-466-6939
Practice Address - Fax:805-548-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8693TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70279Medicare UPIN