Healthcare Provider Details

I. General information

NPI: 1053880468
Provider Name (Legal Business Name): ELEMENTS OPTOMETRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 PIER AVE STE C
HERMOSA BEACH CA
90254-3958
US

IV. Provider business mailing address

703 PIER AVE STE C
HERMOSA BEACH CA
90254-3958
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-9899
  • Fax: 310-376-1195
Mailing address:
  • Phone: 310-374-9899
  • Fax: 310-376-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: M. CATARINA JANG
Title or Position: PRESIDENT
Credential: OD
Phone: 310-374-9899