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NPI Code Detail

MEDICARE: ELILTA BEREKETAB O.D.

MEDICARE: ELILTA BEREKETAB O.D.
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
1152W00000XOptometristAZ2310AZ

General Provider Information

NPI Number : 1598712002
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELILTA BEREKETAB O.D.
Provider Business Mailing Address
First Line : 1175 S ARIZONA AVE
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-6504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1175 S ARIZONA AVE
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-6504
Country : US
Telephone Number : 480-726-0941
Fax Number : 480-393-8030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 12/10/2025

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Directions to “ ELILTA BEREKETAB O.D.” Practice Location

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