Provider Demographics
NPI:1285763029
Name:EYE SURGICAL MEDICAL GROUP OF SANTA BARBARA INC.
Entity type:Organization
Organization Name:EYE SURGICAL MEDICAL GROUP OF SANTA BARBARA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-564-8917
Mailing Address - Street 1:533 E MICHELTORENA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2200
Mailing Address - Country:US
Mailing Address - Phone:805-564-8917
Mailing Address - Fax:805-564-8917
Practice Address - Street 1:533 E MICHELTORENA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2200
Practice Address - Country:US
Practice Address - Phone:805-564-8917
Practice Address - Fax:805-564-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74574ZMedicaid
CAZZZ74574ZMedicaid