Provider Demographics
NPI:1508065418
Name:DESARIO, ELAINE NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:NICOLE
Last Name:DESARIO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:112 S VINSON AVE
Mailing Address - Street 2:SUITE 143
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1155
Mailing Address - Country:US
Mailing Address - Phone:606-638-4731
Mailing Address - Fax:606-393-6563
Practice Address - Street 1:2160 SIR BARTON WAY
Practice Address - Street 2:SUITE 143
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2228
Practice Address - Country:US
Practice Address - Phone:859-543-0857
Practice Address - Fax:859-543-0737
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY1701DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist