Provider Demographics
NPI:1295081024
Name:MCELROY, TIFFANY LI (OD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LI
Last Name:MCELROY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6947 CRUMPLER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1922
Mailing Address - Country:US
Mailing Address - Phone:662-893-3300
Mailing Address - Fax:
Practice Address - Street 1:6947 CRUMPLER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1922
Practice Address - Country:US
Practice Address - Phone:662-893-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist