Provider Demographics
NPI:1467447243
Name:ROBERT SCOTT KAPUST OD INC
Entity Type:Organization
Organization Name:ROBERT SCOTT KAPUST OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KAPUST
Authorized Official - Suffix:
Authorized Official - Credentials:BA BS OD
Authorized Official - Phone:310-374-9899
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3943
Mailing Address - Country:US
Mailing Address - Phone:310-374-9899
Mailing Address - Fax:310-376-1195
Practice Address - Street 1:703 PIER AVE
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3943
Practice Address - Country:US
Practice Address - Phone:310-374-9899
Practice Address - Fax:310-376-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA6261T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY045Medicare ID - Type Unspecified
T70100Medicare UPIN