Provider Demographics
NPI:1831263995
Name:DRS ELLIOTT & WEBB, S.C.
Entity type:Organization
Organization Name:DRS ELLIOTT & WEBB, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:608-742-7133
Mailing Address - Street 1:304 W COOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2108
Mailing Address - Country:US
Mailing Address - Phone:608-742-7133
Mailing Address - Fax:608-745-1603
Practice Address - Street 1:304 W COOK ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2108
Practice Address - Country:US
Practice Address - Phone:608-742-7133
Practice Address - Fax:608-745-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2646-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38712200Medicaid
WI38712200Medicaid
WI38712200Medicaid
WIMW0890574OtherDEA