Provider Demographics
NPI:1285671594
Name:ELLIAS, GAIL NELSON (OD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:NELSON
Last Name:ELLIAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3916 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-1307
Mailing Address - Country:US
Mailing Address - Phone:323-234-9137
Mailing Address - Fax:323-235-6203
Practice Address - Street 1:3916 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1307
Practice Address - Country:US
Practice Address - Phone:323-234-9137
Practice Address - Fax:323-235-6203
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9755 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist