Healthcare Provider Details

I. General information

NPI: 1073286852
Provider Name (Legal Business Name): ELENI SEHREMELIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MADISON AVE FL 2
NEW YORK NY
10016-0069
US

IV. Provider business mailing address

11376 BASKERVILLE RD
LOS ALAMITOS CA
90720-2928
US

V. Phone/Fax

Practice location:
  • Phone: 212-689-7676
  • Fax:
Mailing address:
  • Phone: 562-881-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: