Provider Demographics
NPI:1245678028
Name:ELMORE, ELLEN OWEN (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:OWEN
Last Name:ELMORE
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 1:1492 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8625
Mailing Address - Country:US
Mailing Address - Phone:931-648-0544
Mailing Address - Fax:931-648-3625
Practice Address - Street 1:1492 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8625
Practice Address - Country:US
Practice Address - Phone:931-648-0544
Practice Address - Fax:931-648-3625
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist