Provider Demographics
NPI:1760654537
Name:JOHN J ELIOPULOS O.D. INC
Entity Type:Organization
Organization Name:JOHN J ELIOPULOS O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELIOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-685-6100
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:95624-2073
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:95624-2073
Practice Address - Country:US
Practice Address - Phone:916-685-6100
Practice Address - Fax:916-685-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty