Provider Demographics
NPI:1598906729
Name:PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:805-473-6640
Mailing Address - Street 1:3165 BROAD ST STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6755
Mailing Address - Country:US
Mailing Address - Phone:805-545-7881
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:931 OAK PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3404
Practice Address - Country:US
Practice Address - Phone:805-437-6640
Practice Address - Fax:805-473-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2685147207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18344Medicare PIN
CA6235720004Medicare NSC