Healthcare Provider Details

I. General information

NPI: 1467447243
Provider Name (Legal Business Name): ROBERT SCOTT KAPUST OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 PIER AVE
HERMOSA BEACH CA
90254-3943
US

IV. Provider business mailing address

703 PIER AVE
HERMOSA BEACH CA
90254-3943
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 NumberCA6261T
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT SCOTT KAPUST
Title or Position: PRESIDENT
Credential: BA BS OD
Phone: 310-374-9899