MEDICARE: DR. ELIZABETH CAMARA OD

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	0P8970	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410046447	OTHER	CA	PALMETTO
2	SD0089700	OTHER	CA	MEDI CAL
3	1306035118	OTHER	CA	NPI-ADVANCED EYECARE GROUP
4	6191070001	OTHER	CA	DMEPOS-ADVANCED EYECARE GROUP PTAN

General Provider Information

NPI Number	:	1952383507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH CAMARA OD

Provider Business Mailing Address
First Line	:	4317 NEOSHO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6131
Country	:	US
Telephone Number	:	310-751-6704
Fax Number	:	310-751-6704

Provider Business Practice Location Address
First Line	:	18855 VICTORY BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6445
Country	:	US
Telephone Number	:	310-751-6704
Fax Number	:	310-751-6704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/29/2016

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Directions to “ DR. ELIZABETH CAMARA OD” Practice Location

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