Provider Demographics
NPI:1518959352
Name:MCELROY, TED A (OD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:A
Last Name:MCELROY
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:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1186
Mailing Address - Country:US
Mailing Address - Phone:229-382-4765
Mailing Address - Fax:229-382-4819
Practice Address - Street 1:2012 PINEVIEW AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3035
Practice Address - Country:US
Practice Address - Phone:229-382-4765
Practice Address - Fax:229-382-4819
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2021-02-25
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
GA001397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00571513BMedicaid
GA410029773OtherMEDICARE RAILROAD
GA410029773OtherMEDICARE RAILROAD
GA1088970001Medicare NSC
GA00571513BMedicaid