Organization · NPI-2
17th Street Optometry Apc
Optometrist · Tustin, CA
NPI number1891268678
StatusActive
Last updated in NPPESNov 5, 2026
Details
- NPI
- 1891268678
- Entity type
- Organization (NPI-2)
- Legal business name
- 17th Street Optometry Apc
- Organization subpart
- No
- Enumeration date
- Jan 4, 2019
- Certification date
- Nov 5, 2026
- Last updated
- Nov 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
| 152WC0802X | Optometrist, Corneal and Contact Management | – | – | |
| 152WP0200X | Optometrist, Pediatrics | – | – | |
| 152WX0102X | Optometrist, Occupational Vision | – | – |
Practice location
17400 Irvine Blvd Ste NTustin, CA 92780-3030
Phone 714-838-9664 · Fax 714-838-6774
Mailing address
17400 Irvine Blvd Ste NTustin, CA 92780-3030
Phone 714-838-9664 · Fax 714-386-7268
Authorized official
Alexander Elson
Optometrist
9493387027
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