Provider Demographics
NPI:1558355040
Name:CAINE, ELLIOTT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:J
Last Name:CAINE
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 1:5016 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1714
Mailing Address - Country:US
Mailing Address - Phone:626-403-9810
Mailing Address - Fax:626-403-4597
Practice Address - Street 1:5016 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1714
Practice Address - Country:US
Practice Address - Phone:626-403-9810
Practice Address - Fax:626-403-4597
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6005T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU28908Medicare UPIN