Provider Demographics
NPI:1497713903
Name:ELLIOTT, PAUL WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:ELLIOTT
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 1:25 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2011
Mailing Address - Country:US
Mailing Address - Phone:508-543-4840
Mailing Address - Fax:508-698-1013
Practice Address - Street 1:25 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2011
Practice Address - Country:US
Practice Address - Phone:508-543-4840
Practice Address - Fax:508-698-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3194TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA403058Medicaid
MA1281204OtherFALLON
MA0353531OtherMASS HEALTH
MA5362469OtherAETNA
MAW15861OtherBCBS
MAC30461174OtherCIGNA
MA150731OtherHPHC
MA0353531OtherMASS HEALTH
MA150731OtherHPHC