Provider Demographics
NPI:1386956308
Name:ELSA PAO OD INC
Entity type:Organization
Organization Name:ELSA PAO OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-238-9797
Mailing Address - Street 1:901 FRANKLIN ST STE 68
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4476
Mailing Address - Country:US
Mailing Address - Phone:510-238-9797
Mailing Address - Fax:
Practice Address - Street 1:901 FRANKLIN ST STE 68
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4476
Practice Address - Country:US
Practice Address - Phone:510-238-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty