Provider Demographics
NPI:1992752794
Name:SIERRA EYE AMBULATORY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SIERRA EYE AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-893-0471
Mailing Address - Street 1:2830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4331
Mailing Address - Country:US
Mailing Address - Phone:559-734-7272
Mailing Address - Fax:559-733-7438
Practice Address - Street 1:2828 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4331
Practice Address - Country:US
Practice Address - Phone:559-734-7272
Practice Address - Fax:559-733-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-C0001473OtherDEPT HEALTH & HUMAN SERVI
CASUR01473FMedicaid
CASUR01473FMedicaid