Healthcare Provider Details

I. General information

NPI: 1720561855
Provider Name (Legal Business Name): ELIZABETH NACE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE 318
LOS ANGELES CA
90025-5395
US

IV. Provider business mailing address

6345 BALBOA BLVD BLDG 3 STE 250
ENCINO CA
91316
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-4009
  • Fax:
Mailing address:
  • Phone: 818-344-3937
  • Fax: 818-344-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number34392TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number27OA00681200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number34392TLG
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number27OA00681200
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number34392TLG
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00681200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: