Provider Demographics
NPI:1457913733
Name:ELAVSKY, BROOKE WEISENBUGER (OD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:WEISENBUGER
Last Name:ELAVSKY
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 1:2600 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5311
Mailing Address - Country:US
Mailing Address - Phone:419-625-6181
Mailing Address - Fax:419-625-7493
Practice Address - Street 1:2600 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5311
Practice Address - Country:US
Practice Address - Phone:419-625-6181
Practice Address - Fax:419-625-7493
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist