Organization
ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Active
Other names
Kendall Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN BYLSMA MD (PRESIDENT)
(805) 925-2637
Entity
Organization
Contact information
Practice address
425 W CENTRAL AVE STE 102, LOMPOC, CA 93436
(805) 736-2020
(805) 737-1733
Mailing address
910 E STOWELL RD, SANTA MARIA, CA 93454-7001
(805) 925-2637
(805) 347-0033
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086920
—
CA
05
—
GSD004611
—
CA
01
—
ZZZ61060Z
BLUE SHIELD OF CA
CA
Enumeration date
05/02/2006
Last updated
10/10/2018
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