Provider Demographics
NPI:1619930500
Name:ELIOPULOS, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:ELIOPULOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9074 ELK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2046
Mailing Address - Country:US
Mailing Address - Phone:916-685-6100
Mailing Address - Fax:916-685-0279
Practice Address - Street 1:9074 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2046
Practice Address - Country:US
Practice Address - Phone:916-685-6100
Practice Address - Fax:916-685-0279
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist