Organization
JACK M. ELIZARES OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK M. ELIZARES OD (CEO, CFO)
(707) 994-8641
Entity
Organization
Contact information
Practice address
3610 OLD HWY 53, CLEARLAKE, CA 95422-9543
(707) 994-8641
(707) 994-5858
Mailing address
3610 OLD HIGHWAY 53, CLEARLAKE, CA 95422-9253
(707) 994-8641
(707) 994-5858
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0066460
—
CA
Enumeration date
10/06/2017
Last updated
10/06/2017
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