Provider Demographics
NPI:1588629984
Name:ELCOCK, DONNA LEONNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LEONNE
Last Name:ELCOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3102
Mailing Address - Country:US
Mailing Address - Phone:610-284-0777
Mailing Address - Fax:
Practice Address - Street 1:538 CHURCH LN
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3102
Practice Address - Country:US
Practice Address - Phone:610-284-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001054152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA73236OtherAETNA
PA0530914000OtherKEYSTONE HEALTH PLAN EAST
PA01622622Medicaid
PW695858OtherPERSONAL CHOICE/ BLUE CHO
PA0530914000OtherKEYSTONE HEALTH PLAN EAST
PAU 29702Medicare UPIN