Provider Demographics
NPI:1801135363
Name:BELMONT SHORE OPTOMETRIC ASSOCIATES INC.
Entity type:Organization
Organization Name:BELMONT SHORE OPTOMETRIC ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-438-1211
Mailing Address - Street 1:5219 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5316
Mailing Address - Country:US
Mailing Address - Phone:562-438-1211
Mailing Address - Fax:562-438-0821
Practice Address - Street 1:5219 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5316
Practice Address - Country:US
Practice Address - Phone:562-438-1211
Practice Address - Fax:562-438-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11866T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB632AMedicare PIN