Provider Demographics
NPI:1962003582
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:805-503-1009
Mailing Address - Street 1:PO BOX 5357
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-5357
Mailing Address - Country:US
Mailing Address - Phone:805-503-1009
Mailing Address - Fax:805-548-8785
Practice Address - Street 1:1140 E CLARK AVE STE 160
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-5188
Practice Address - Country:US
Practice Address - Phone:805-503-1009
Practice Address - Fax:805-548-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty