NPIMap

Organization Active NPI

Pacific Eye Surgeons, a California Professional Medical Corporation

  • Eyewear Supplier
  • Visalia, CA
National Provider Identifier
1013702802
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION
Practice address
2830 W Main St
Visalia, CA 93291-4331
Phone
(559) 636-1000
NPI assigned
Apr 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Clifton Chad Bazhaw
Title
Chief Finacial Officer
Phone
(469) 270-6658

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

2830 W Main St
Visalia, CA 93291-4331

Mailing address

3855 Broad St Ste B
San Luis Obispo, CA 93401-7109
Phone (805) 545-7881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250825001274 CA DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 7810947397 Practice locations: Visalia, CA

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pacific Eye Surgeons a California Professional Medical Corporation10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3855 Broad St
#B
San Luis Obispo, CA 93401
Phone (805) 545-7881

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744329600000",
    "number": "1013702802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 BROAD ST STE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017109",
            "telephone_number": "805-545-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 W MAIN ST",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932914331",
            "telephone_number": "559-636-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYE SURGEONS, A CALIFORNIA PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A",
        "authorized_official_last_name": "BAZHAW",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "CHIEF FINACIAL OFFICER",
        "authorized_official_telephone_number": "469-270-6658"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.