Provider Demographics
NPI:1932112612
Name:PAO, ELSA T (OD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:T
Last Name:PAO
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 1:901 FRANKLIN ST STE 68
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4476
Mailing Address - Country:US
Mailing Address - Phone:510-238-9797
Mailing Address - Fax:
Practice Address - Street 1:901 FRANKLIN ST
Practice Address - Street 2:#68
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4472
Practice Address - Country:US
Practice Address - Phone:650-278-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist