Provider Demographics
NPI:1922523315
Name:HUBER, ELENA (OD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:547 BROOKS AVE APT A
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-6091
Mailing Address - Country:US
Mailing Address - Phone:260-341-7121
Mailing Address - Fax:
Practice Address - Street 1:200 N ROBERTSON BLVD STE 303
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-6001
Practice Address - Country:US
Practice Address - Phone:310-385-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist