Provider Demographics
NPI:1467517326
Name:ELHAJ, RICHARD R (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:ELHAJ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6600 TOPANGA CANYON BLVD
Mailing Address - Street 2:TOPANGA PLAZA SP 1
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2609
Mailing Address - Country:US
Mailing Address - Phone:818-883-8220
Mailing Address - Fax:818-348-7724
Practice Address - Street 1:6600 TOPANGA CANYON BLVD
Practice Address - Street 2:TOPANGA PLAZA SP 1
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2609
Practice Address - Country:US
Practice Address - Phone:818-883-8220
Practice Address - Fax:818-348-7724
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11629T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11629EMedicare ID - Type Unspecified
CAU88017Medicare UPIN