MEDICARE: BELMONT SHORE OPTOMETRIC ASSOCIATES 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	11866T	CA

General Provider Information

NPI Number	:	1801135363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELMONT SHORE OPTOMETRIC ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	5219 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5316
Country	:	US
Telephone Number	:	562-438-1211
Fax Number	:	562-438-0821

Provider Business Practice Location Address
First Line	:	5219 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5316
Country	:	US
Telephone Number	:	562-438-1211
Fax Number	:	562-438-0821

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ELAINA CHIAO
Credential	:	O.D.
Telephone Number	:	562-438-1211

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	05/16/2013

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