Provider Demographics
NPI:1801065743
Name:DAVIDOFF, ELINA KOLESNIKOV (OD)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:KOLESNIKOV
Last Name:DAVIDOFF
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 1:6485 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4838
Mailing Address - Country:US
Mailing Address - Phone:901-767-3937
Mailing Address - Fax:901-767-3048
Practice Address - Street 1:6485 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4838
Practice Address - Country:US
Practice Address - Phone:901-767-3937
Practice Address - Fax:901-767-3048
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist