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General NPI Number Information
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NPI Number | 1194086306
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Entity Type | Individual
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Provider Name | MELISSA KIMBERLY ELROD O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 3403 E RAYMOND ST STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-4783
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Country | US
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Telephone | 317-957-2070
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Fax | 317-489-6910
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Provider Business Mailing Address
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Address Line | 3403 E RAYMOND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-4782
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Country | US
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Telephone | 317-957-2100
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Fax | 317-957-2120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003725A
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License Number State | IN
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