Provider Demographics
NPI:1134416605
Name:ELTON, THOMAS L (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:ELTON
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 1170
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-6170
Mailing Address - Country:US
Mailing Address - Phone:763-746-2094
Mailing Address - Fax:
Practice Address - Street 1:7000 YORK AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4213
Practice Address - Country:US
Practice Address - Phone:952-929-1159
Practice Address - Fax:952-922-9308
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3231152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3231OtherMN OD LICENSE