Provider Demographics
NPI:1750677753
Name:MCELVAINE, KATIE ROBERTSON (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ROBERTSON
Last Name:MCELVAINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2939 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4015
Mailing Address - Country:US
Mailing Address - Phone:417-881-3937
Mailing Address - Fax:417-202-4112
Practice Address - Street 1:2939 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4015
Practice Address - Country:US
Practice Address - Phone:417-881-3937
Practice Address - Fax:417-202-4112
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist