NPIMap

Organization Active NPI

Elite Eyecare Medical Group a Medical Corporation

Doing business as Shepard Eye Center

  • Ophthalmology Physician
  • San Luis Obispo, CA
National Provider Identifier
1710216957
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Doing business as
Shepard Eye Center
Practice address
1245 Broad St
San Luis Obispo, CA 93401
Phone
(805) 542-0700
NPI assigned
Dec 17, 2009
Last updated
Oct 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Authorized official

Name
Dr. Stephen S Bylsma, M.D.NPI 1265435325
Title
President
Phone
(805) 925-2637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

1245 Broad St
San Luis Obispo, CA 93401

Mailing address

910 E Stowell Rd
Santa Maria, CA 93454-7001
Phone (805) 925-2637

Other names 1

  • SHEPARD EYE CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050128000937 CA Part B Supplier - Clinic/Group Practice 5597715391 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lompoc, CA; Solvang, CA; Santa Maria, CA; San Luis Obispo, CA; Orcutt, CA; Morro Bay, CA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Elite Eyecare Medical Group a 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.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1710216957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 E STOWELL RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547001",
            "telephone_number": "805-925-2637",
            "fax_number": "805-347-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 BROAD ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93401",
            "telephone_number": "805-542-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "BYLSMA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-925-2637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHEPARD EYE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SHEPARD EYE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 1, 2018; 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.