Provider Demographics
NPI:1083692214
Name:ELSE, JAMES D (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:ELSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH AVE W
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2753
Mailing Address - Country:US
Mailing Address - Phone:641-673-9263
Mailing Address - Fax:641-673-1778
Practice Address - Street 1:200 HIGH AVE W
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2753
Practice Address - Country:US
Practice Address - Phone:641-673-9263
Practice Address - Fax:641-673-1778
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0088500Medicaid
IAU34309Medicare UPIN
IA0088500Medicaid