NPIMap

Organization Active NPI

San Luis Obispo Eye Associates, a Medical Group Inc.

  • Ophthalmology Physician
  • San Luis Obispo, CA
National Provider Identifier
1144400201
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SAN LUIS OBISPO EYE ASSOCIATES, A MEDICAL GROUP INC.
Practice address
689 Tank Farm Rd
San Luis Obispo, CA 93401-7077
Phone
(805) 781-3937
NPI assigned
Nov 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Ms. Christina Lykens, COE
Title
Practice Administrator
Phone
(805) 781-3937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

689 Tank Farm Rd
San Luis Obispo, CA 93401-7077

Mailing address

234 Heather CT
Suite 102
Templeton, CA 93465-8765
Phone (805) 434-5970

Other identifiers 2

IdentifierTypeStateIssuer
GR0068240MedicaidCA
1159330001OtherCADMERC REGION D

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050615001137 CA Part B Supplier - Clinic/Group Practice 3173567518 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis Obispo, CA; Templeton, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1144400201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 HEATHER CT",
            "address_2": "SUITE 102",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934658765",
            "telephone_number": "805-434-5970",
            "fax_number": "805-434-5973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 TANK FARM RD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017077",
            "telephone_number": "805-781-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS OBISPO EYE ASSOCIATES, A MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2022-10-21",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "LYKENS",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "805-781-3937",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "COE"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068240",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC REGION D",
            "identifier": "1159330001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.