Provider Demographics
NPI:1356028914
Name:DOXTADER, ELAINE KELSEY (OD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:KELSEY
Last Name:DOXTADER
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 1:1401 ROUTE 52 STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3255
Mailing Address - Country:US
Mailing Address - Phone:845-897-9500
Mailing Address - Fax:
Practice Address - Street 1:1401 ROUTE 52 STE 200
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3255
Practice Address - Country:US
Practice Address - Phone:845-897-9500
Practice Address - Fax:845-897-4599
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist