Provider Demographics
NPI:1417021361
Name:ELMAN, JOHN WINTON (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WINTON
Last Name:ELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 7TH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2637
Mailing Address - Country:US
Mailing Address - Phone:310-395-5550
Mailing Address - Fax:310-395-3398
Practice Address - Street 1:1431 7TH ST
Practice Address - Street 2:STE. 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2637
Practice Address - Country:US
Practice Address - Phone:310-395-5550
Practice Address - Fax:310-395-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4939T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0049390Medicaid
CASD0049390Medicaid