Provider Demographics
NPI:1205196193
Name:LOU ROY ELDER, O.D., INC.
Entity Type:Organization
Organization Name:LOU ROY ELDER, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-642-0720
Mailing Address - Street 1:1725 WESTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5529
Mailing Address - Country:US
Mailing Address - Phone:949-642-0720
Mailing Address - Fax:949-642-8087
Practice Address - Street 1:1725 WESTCLIFF DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5529
Practice Address - Country:US
Practice Address - Phone:949-642-0720
Practice Address - Fax:949-642-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT3903T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH890AMedicare PIN