Individual
DR. JACK M ELIZARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3610 OLD HIGHWAY 53, CLEARLAKE, CA 95422-9253
(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
01/19/2006
Last updated
03/09/2009
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