# ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shepard Eye Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578521472
- **Authorized official:** STEPHEN BYLSMA MD (PRESIDENT)
- **Authorized official phone:** (805) 925-2637

## Contact information

- **Practice address:** 910 E STOWELL RD, SANTA MARIA, CA 93454
- **Practice address phone:** (805) 925-2637
- **Practice address fax:** (805) 347-0033
- **Mailing address:** 910 E STOWELL RD, SANTA MARIA, CA 93454-7001
- **Mailing address phone:** (805) 925-2637
- **Mailing address fax:** (805) 347-0033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 01/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0086921 | — | CA |
| 05 | — | GSD004610 | — | CA |
| 01 | — | ZZZ61059Z | BLUE SHIELD OF CA | CA |