Provider Demographics
NPI:1437149069
Name:ELG, DARREN EUGENE (OD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:EUGENE
Last Name:ELG
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 1:20715 E OCOTILLO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-6118
Mailing Address - Country:US
Mailing Address - Phone:480-987-3400
Mailing Address - Fax:480-987-3406
Practice Address - Street 1:20715 E OCOTILLO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-6118
Practice Address - Country:US
Practice Address - Phone:480-987-3400
Practice Address - Fax:480-987-3406
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619265Medicaid
AZZ134882Medicare PIN
AZU84355Medicare UPIN
AZ4400520001Medicare NSC