RETINA SPECIALISTS OF THE CENTRAL COAST INC (NPI# 1821271248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821271248 |
| Entity Type | Organization |
| Organization Name | RETINA SPECIALISTS OF THE CENTRAL COAST INC |
| Practice Address |
628 California Blvd Suite C San Luis Obispo CA 93401-2542 |
| Practice Telephone | 8055472090 |
| Practice Fax Number | 8055472095 |
| Mailing Telephone | 8055472090 |
| Mailing Fax Number | 8055472095 |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2009-11-18 |
| Authorized Official Name | DEREK B. LAURITZEN (PRESIDENT) |
| Authorized Official Telephone | 8055472090 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | C3049777 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD OF CALIFORNIA | ZZZ50256Y | 01 |
| OWCP | 613177600 | 01 | |
| CA | CA STATE LICENSE | C3049777 | 01 |
| Street Address |
628 CALIFORNIA BLVD SUITE C |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93401-2542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548262751 | Pacific Eye Surgeons, A California Professional Medical Corporation | Ophthalmology | 628 California Blvd, Ste D, San Luis Obispo, CA 93401-2558 | 2005-06-01 |
| 1275958571 | Brian Bolenbaugh | Hearing Instrument Specialist | 628 California Blvd, Suite F, San Luis Obispo, CA 93401-2542 | 2014-02-23 |
| 1841515202 | Randall L Lonsbrough D D S Inc | Dentist | 628 California Blvd, Suite F1, San Luis Obispo, CA 93401-2542 | 2010-03-29 |
| 1508054685 | Duistermars Optometric Corporation | Optometrist | 628 California Blvd, Ste. C, San Luis Obispo, CA 93401-2542 | 2007-10-14 |
| 1366595639 | Kimberly D Johnson | Optometrist | 628 California Blvd, Ste D, San Luis Obispo, CA 93401-2542 | 2007-01-19 |
| 1366551558 | Brendan V Mcadams Jr. | Orthopaedic Surgery | 628 California Blvd, Suite D2, San Luis Obispo, CA 93401-2559 | 2006-08-30 |
| 1841208758 | Central Coast Eye Associates Inc | Ophthalmology | 628 California Blvd, Ste C, San Luis Obispo, CA 93401 | 2006-08-04 |
| 1326056235 | Mark D Sherman | Ophthalmology | 628 California Blvd, Ste D, San Luis Obispo, CA 93401 | 2006-08-04 |
| 1679581581 | Steven C Johnson | Ophthalmology | 628 California Blvd, Ste C, San Luis Obispo, CA 93401 | 2006-08-04 |
| 1750397410 | Randall L Lonsbrough | Dentist | 628 California Blvd, Ste F1, San Luis Obispo, CA 93401-2574 | 2006-08-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497228399 | Barbara Jean Morrow | Dental Hygienist | 2191 Johnson Avenue, San Luis Obispo, CA 93401 | 2019-01-03 |
| 1104307743 | Griffith Jennings | Counselor | 1225 Kendal Rd, San Luis Obispo, CA 93401 | 2018-08-22 |
| 1124518808 | Joy L Delaluna | Licensed Psychiatric Technician | 692 Evens Rd, San Luis Obispo, CA 93401 | 2018-05-17 |
| 1982192084 | Sierra Mental Wellness Group | Community/Behavioral Health | 2180 B Johnson Avenue, San Luis Obispo, CA 93401 | 2018-04-25 |
| 1326554403 | Veronica Chanel Laguna | Case Manager/Care Coordinator | 1065 Kansas Ave., San Luis Obispo, CA 93401 | 2017-12-27 |
| 1043739782 | Janette Lynn Branca | Case Manager/Care Coordinator | 285 South Street, Suit J, San Louis Obispo, CA 93401 | 2017-09-13 |
| 1588194104 | Adv Vision LLC | Optometrist | 835 Aero Vista Pl, #110, San Luis Obispo, CA 93401 | 2017-06-15 |
| 1508395880 | Samantha Clay | Counselor | 1255 Kendall Road, San Luis Obispo, CA 93401 | 2017-06-08 |
| 1659804771 | Sara Anne Powers | Counselor | 697 Higuera Street D, San Luis Obispo, CA 93401 | 2017-04-05 |
| 1508306010 | Russell Piazza | Pharmacist | 873 Ricardo Court, San Luis Obispo, CA 93401 | 2017-03-02 |
| Find all providers in zip 93401 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841348166 | Derek Brian Lauritzen | Ophthalmology | 941 California Blvd, San Luis Obispo, CA 93401 | 2007-01-05 |
| 1871501783 | Glenn F Oelker | Ophthalmology | 689 Tank Farm Rd, Suite 100, San Luis Obispo, CA 93401-7077 | 2006-08-04 |
| 1831145739 | Sharon M Theodore | Ophthalmology | 689 Tank Farm Rd Ste 100, San Luis Obispo, CA 93401-7078 | 2006-05-25 |
| 1609878834 | Robert W Higginbotham | Ophthalmology | 3855 Broad Street, Ste B, San Luis Obispo, CA 93401 | 2005-06-01 |
| 1548262751 | Pacific Eye Surgeons, A California Professional Medical Corporation | Ophthalmology | 628 California Blvd, Ste D, San Luis Obispo, CA 93401-2558 | 2005-06-01 |
| 1124021746 | John Burley Cotter | Ophthalmology | 1270 Peach St, San Luis Obispo, CA 93401-2856 | 2005-05-27 |
| 1760982300 | Elite Eyecare Medical Group A Medical Corporation | Ophthalmology | 437 Marsh St, San Luis Obispo, CA 93401 | 2018-02-20 |
| 1710216957 | Elite Eyecare Medical Group A Medical Corporation | Ophthalmology | 1245 Broad St, San Luis Obispo, CA 93401 | 2009-12-17 |
| 1467500686 | John William Hallisey | Ophthalmology | 1270 Peach St, San Luis Obispo, CA 93401-2856 | 2007-01-05 |
| 1063569655 | Michael Borg Limberg | Ophthalmology | 1270 Peach St, San Luis Obispo, CA 93401-2856 | 2007-01-04 |
| Find all providers in SAN LUIS OBISPO | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.