Provider Demographics
NPI:1699222950
Name:DR ELLIOTT SHAPIRO, FAMILY OPTOMETRY INC.
Entity Type:Organization
Organization Name:DR ELLIOTT SHAPIRO, FAMILY OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-774-2931
Mailing Address - Street 1:7056 SITIO CALIENTE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2042
Mailing Address - Country:US
Mailing Address - Phone:858-774-2931
Mailing Address - Fax:
Practice Address - Street 1:4353 LA JOLLA VILLAGE DR
Practice Address - Street 2:SUITE H20
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1259
Practice Address - Country:US
Practice Address - Phone:858-622-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-04
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty