Provider Demographics
NPI:1942573225
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:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-545-7881
Mailing Address - Street 1:3165 BROAD ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6778
Mailing Address - Country:US
Mailing Address - Phone:805-545-7881
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-545-8100
Practice Address - Fax:805-735-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2685147207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty