Provider Demographics
NPI:1699855122
Name:MCGRATH, ELAINE G (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:G
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6176 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2410
Mailing Address - Country:US
Mailing Address - Phone:317-255-9507
Mailing Address - Fax:
Practice Address - Street 1:1906 S SCATTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5725
Practice Address - Country:US
Practice Address - Phone:765-644-0506
Practice Address - Fax:765-622-0958
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003159B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU90483Medicare UPIN