| San Luis Obispo Eye Associates, A Medical Group Inc | |
|
234 Heather Ct, Suite 102, Templeton, CA 93465-8765 | |
| (805) 434-5970 | |
| (805) 434-5973 |
| Full Name | San Luis Obispo Eye Associates, A Medical Group Inc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 234 Heather Ct, Templeton, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366409898 | NPI | - | NPPES |
| GR0068240 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 332H00000X | Eyewear Supplier | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Rupert C Chowins |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1750368304 PECOS PAC ID: 5496658015 Enrollment ID: I20051220000638 |
| Provider Name | Abraham Suhr |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1114991676 PECOS PAC ID: 7810990751 Enrollment ID: I20060816000138 |
| Provider Name | Frank Mark Basich |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1811902257 PECOS PAC ID: 2860577111 Enrollment ID: I20101004000401 |
| Provider Name | Rena Artemis Stathacopoulos |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1881609238 PECOS PAC ID: 3678658929 Enrollment ID: I20101011001156 |
| Provider Name | Joseph Roy Horne |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912914482 PECOS PAC ID: 1557553245 Enrollment ID: I20101013000876 |
| Provider Name | William J Gealy |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1013922467 PECOS PAC ID: 9133204480 Enrollment ID: I20101015001244 |
| Provider Name | Larry Bryan Baldwin |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1205843786 PECOS PAC ID: 6305921651 Enrollment ID: I20101018001115 |
| Provider Name | Stephen Scott Bylsma |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1265435325 PECOS PAC ID: 8224088026 Enrollment ID: I20110203000495 |
| Provider Name | Marques Bostic |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265753404 PECOS PAC ID: 3779768742 Enrollment ID: I20191210002912 |
| Provider Name | Daniel R Agarwal |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1811230766 PECOS PAC ID: 8820365851 Enrollment ID: I20200729002573 |
| Provider Name | David Earl Bowin |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1487271243 PECOS PAC ID: 9739580960 Enrollment ID: I20210625001242 |
| Provider Name | Jason Daniel Bunker |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568133692 PECOS PAC ID: 5092104539 Enrollment ID: I20211122002918 |
| Provider Name | Leia Michelle Dumlao Ballesteros |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1205557550 PECOS PAC ID: 4880060953 Enrollment ID: I20221013002669 |
| Mailing Address | Practice Location Address |
|---|---|
| San Luis Obispo Eye Associates, A Medical Group Inc 234 Heather Ct, Suite 102, Templeton, CA 93465-8765 Ph: (805) 434-5970 | San Luis Obispo Eye Associates, A Medical Group Inc 234 Heather Ct, Suite 102, Templeton, CA 93465-8765 Ph: (805) 434-5970 |