Provider Demographics
NPI:1982759197
Name:ELGES, EDMUND TIMOTHY (OD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:TIMOTHY
Last Name:ELGES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32925 GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3155
Mailing Address - Country:US
Mailing Address - Phone:586-293-8888
Mailing Address - Fax:586-293-8940
Practice Address - Street 1:32925 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3155
Practice Address - Country:US
Practice Address - Phone:586-293-8888
Practice Address - Fax:586-293-8940
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU35736Medicare UPIN