Individual
MR. BRIAN EDWARD ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6331 JACKSON AVE, RIVERBANK, CA 95367
(209) 869-3300
(209) 869-8809
Mailing address
6331 JACKSON AVE, RIVERBANK, CA 95367-2733
(209) 869-3300
(209) 869-8809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9440T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0723780001
MEDICARE DME PIN
CA
05
—
SD0094401
—
CA
Enumeration date
10/25/2006
Last updated
09/01/2022
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