Organization
PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFTON CHAD BAZHAW (CHIEF REVENUE OFFICER)
(214) 893-0471
Entity
Organization
Contact information
Practice address
3855 BROAD ST STE B, SAN LUIS OBISPO, CA 93401-7109
(805) 545-8100
Mailing address
3165 BROAD ST, SUITE 112, SAN LUIS OBISPO, CA 93401-6778
(805) 545-7881
(805) 548-8785
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2685147
CA
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
602017000
USDL PIN
—
01
—
DC7249
RR MEDICARE GRP PIN
—
05
—
GR0099340
—
CA
01
—
ZZZ09808Z
BLUE SHIELD OF CA GRP PIN
CA
Enumeration date
06/01/2005
Last updated
02/10/2026
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