Provider Demographics
NPI:1801183975
Name:KAO, ELAINE (OD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 WESTMINSTER MALL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4947
Mailing Address - Country:US
Mailing Address - Phone:714-897-1550
Mailing Address - Fax:714-897-3596
Practice Address - Street 1:2056 WESTMINSTER MALL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4947
Practice Address - Country:US
Practice Address - Phone:714-897-1550
Practice Address - Fax:714-897-3596
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist