MEDICARE: ROBERT SCOTT KAPUST OD INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	CA6261T	CA

General Provider Information

NPI Number	:	1467447243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT SCOTT KAPUST OD INC

Provider Business Mailing Address
First Line	:	703 PIER AVE
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3943
Country	:	US
Telephone Number	:	310-374-9899
Fax Number	:	310-376-1195

Provider Business Practice Location Address
First Line	:	703 PIER AVE
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3943
Country	:	US
Telephone Number	:	310-374-9899
Fax Number	:	310-376-1195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT SCOTT KAPUST
Credential	:	BA BS OD
Telephone Number	:	310-374-9899

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	08/22/2020

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