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General NPI Number Information
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NPI Number | 1215054291
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Entity Type | Organization
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Legal Business Name | DR. KEVIN MCELROY, OD PA
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 01/01/2014
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Provider Practice Location Address
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Address Line | 50 E CARMEL DR
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City | MERIDIAN
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State | ID
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Zip | 83646-3301
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Country | US
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Telephone | 208-888-5252
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Fax | 208-884-4280
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Provider Business Mailing Address
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Address Line | 50 E CARMEL DR
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City | MERIDIAN
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State | ID
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Zip | 83646-3301
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Country | US
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Telephone | 208-888-5252
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Fax | 208-884-4280
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN W MCELROY
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Credential | O.D. P.A.
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Telephone | 208-888-5252
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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 | O-653
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License Number State | ID
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