Provider Demographics
NPI:1689058919
Name:MCGOWIN, ELNA
Entity Type:Individual
Prefix:
First Name:ELNA
Middle Name:
Last Name:MCGOWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELNA
Other - Middle Name:
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27900N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7077
Mailing Address - Country:US
Mailing Address - Phone:251-621-1211
Mailing Address - Fax:251-621-9052
Practice Address - Street 1:27900 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7078
Practice Address - Country:US
Practice Address - Phone:251-621-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSD40152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist