Provider Demographics
NPI:1952383507
Name:CAMARA, ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:CAMARA
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 1:4317 NEOSHO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6131
Mailing Address - Country:US
Mailing Address - Phone:310-751-6704
Mailing Address - Fax:310-751-6704
Practice Address - Street 1:18855 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6445
Practice Address - Country:US
Practice Address - Phone:310-751-6704
Practice Address - Fax:310-751-6704
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0P8970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410046447OtherPALMETTO
CASD0089700OtherMEDI CAL
CA1306035118OtherNPI-ADVANCED EYECARE GROUP
CA6191070001OtherDMEPOS-ADVANCED EYECARE GROUP PTAN
CABF492AMedicare PIN
CASD0089700OtherMEDI CAL
CAU28249Medicare UPIN
CABF515ZMedicare PIN