Healthcare Provider Details

I. General information

NPI: 1609231752
Provider Name (Legal Business Name): STEVEN D. ELLIOTT, O.D. & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 ANDERSONVILLE HWY STE 101
CLINTON TN
37716-6706
US

IV. Provider business mailing address

2681 ANDERSONVILLE HWY STE 101
CLINTON TN
37716-6706
US

V. Phone/Fax

Practice location:
  • Phone: 865-457-2020
  • Fax: 865-494-3930
Mailing address:
  • Phone: 865-457-2020
  • Fax: 865-494-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD000002347
License Number StateTN

VIII. Authorized Official

Name: DR. STEVEN D ELLIOTT
Title or Position: OWNER/PRESIDENT
Credential: OD
Phone: 865-922-3937