Provider Demographics
NPI:1841314242
Name:WITTEN, ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:WITTEN
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 1:60 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6217
Mailing Address - Country:US
Mailing Address - Phone:239-261-7071
Mailing Address - Fax:239-263-0807
Practice Address - Street 1:60 10TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6217
Practice Address - Country:US
Practice Address - Phone:239-261-7071
Practice Address - Fax:239-263-0807
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 001705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000219700Medicaid
FLT84150Medicare UPIN
FL000219700Medicaid