Jack M Elizares, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6646 Issued in CA

Practice address

3610 Old Highway 53
Clearlake, CA 95422-9253

Phone

(707) 994-8641

Fax

(707) 994-5858

NPI assigned

Jan 19, 2006

Last updated

Mar 9, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of California - School of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jack M. Elizares Optometric Corporation

  • Optometrist
  • Clearlake, CA
  • NPI 1164932976
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236556800000",
    "number": "1295715712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 OLD HIGHWAY 53",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229253",
            "telephone_number": "707-994-8641",
            "fax_number": "707-994-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 OLD HIGHWAY 53",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229253",
            "telephone_number": "707-994-8641",
            "fax_number": "707-994-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZARES",
        "first_name": "JACK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2009-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0066460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Dytche
• Edgar Ontiveros
• Janet M Edmonds, COUNSELOR CAS, RAS
• Malka Rhonda Eisgrau, LPC, LPN
• Peter Monroe Eliot
• Tia Ellis
• Eye Associates of Sebastopol Medical Group
• Daniel Feeney
• Delmer Fjarli, M.D.
• Debra Marie Fleming, RASI

• Optometrist in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.