Provider Demographics
NPI:1407812027
Name:ELDRED, DAVID CARLYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARLYLE
Last Name:ELDRED
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 1:2029 BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7368
Mailing Address - Country:US
Mailing Address - Phone:307-638-2020
Mailing Address - Fax:307-634-0939
Practice Address - Street 1:2029 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7368
Practice Address - Country:US
Practice Address - Phone:307-638-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY250-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113391800Medicaid
WYW304393Medicare ID - Type Unspecified
WY113391800Medicaid