MEDICARE: DRS. ELLIOTT & WEBB, S.C.

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	2646-035	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588746671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. ELLIOTT & WEBB, S.C.

Provider Business Mailing Address
First Line	:	1205 SUFFOLK DR
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53546-1606
Country	:	US
Telephone Number	:	608-754-3379
Fax Number	:	608-741-1506

Provider Business Practice Location Address
First Line	:	1205 SUFFOLK DR
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53546-1606
Country	:	US
Telephone Number	:	608-754-3379
Fax Number	:	608-741-1506

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HERBERT T WEBB III
Credential	:	O.D.
Telephone Number	:	608-754-3379

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	11/10/2008

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