MEDICARE: DR. MELISSA KIMBERLY ELROD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003725A	IN

General Provider Information

NPI Number	:	1194086306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA KIMBERLY ELROD O.D.

Provider Business Mailing Address
First Line	:	3403 E RAYMOND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4782
Country	:	US
Telephone Number	:	317-957-2100
Fax Number	:	317-957-2120

Provider Business Practice Location Address
First Line	:	3403 E RAYMOND ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4783
Country	:	US
Telephone Number	:	317-957-2070
Fax Number	:	317-489-6910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	03/04/2025

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