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General NPI Number Information
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NPI Number | 1457913733
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Entity Type | Individual
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Provider Name | BROOKE WEISENBUGER ELAVSKY OD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 2600 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-5311
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Country | US
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Telephone | 419-625-6181
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Fax | 419-625-7493
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Provider Business Mailing Address
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Address Line | 2600 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-5311
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Country | US
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Telephone | 419-625-6181
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Fax | 419-625-7493
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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 | 006767
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License Number State | OH
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