MEDICARE: ELEMENTS OPTOMETRY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WP0200X	Pediatric Optometrist
3	152WS0006X	Sports Vision Optometrist
4	152WV0400X	Vision Therapy Optometrist
5	152W00000X	Optometrist

General Provider Information

NPI Number	:	1053880468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTS OPTOMETRY P.C.

Provider Business Mailing Address
First Line	:	703 PIER AVE STE C
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3958
Country	:	US
Telephone Number	:	310-374-9899
Fax Number	:	310-376-1195

Provider Business Practice Location Address
First Line	:	703 PIER AVE STE C
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3958
Country	:	US
Telephone Number	:	310-374-9899
Fax Number	:	310-376-1195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	M. CATARINA JANG
Credential	:	OD
Telephone Number	:	310-374-9899

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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