Provider Demographics
NPI:1760809099
Name:ELBECK, PATRICIA ANN (RDO, RSLD,RCLD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:ELBECK
Suffix:
Gender:F
Credentials:RDO, RSLD,RCLD
Other - Prefix:
Other - First Name:PATRISHA
Other - Middle Name:ANN
Other - Last Name:ELBECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDO,RSLD,RCLD
Mailing Address - Street 1:26012 MARGUERITE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3263
Mailing Address - Country:US
Mailing Address - Phone:949-582-3064
Mailing Address - Fax:949-582-3064
Practice Address - Street 1:26012 MARGUERITE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3263
Practice Address - Country:US
Practice Address - Phone:949-582-3064
Practice Address - Fax:949-582-3064
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL40066156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician