Provider Demographics
NPI:1336504711
Name:STEVEN D. ELLIOTT, O.D. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:STEVEN D. ELLIOTT, O.D. & ASSOCIATES, INC.
Other - Org Name:VOLUNTEER EYE CARE, MARYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-922-3937
Mailing Address - Street 1:730 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3900
Mailing Address - Country:US
Mailing Address - Phone:865-982-2020
Mailing Address - Fax:865-970-2020
Practice Address - Street 1:730 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3900
Practice Address - Country:US
Practice Address - Phone:865-982-2020
Practice Address - Fax:865-970-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD000002347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526669Medicaid
TN4290034OtherBLUE CROSS BLUE SHIELD OF TENNESSEE