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General NPI Number Information
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NPI Number | 1578630794
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Entity Type | Organization
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Legal Business Name | TED A MCELROY OD, PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 2012 PINEVIEW AVE
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City | TIFTON
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State | GA
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Zip | 31794-3035
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Country | US
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Telephone | 229-382-4765
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Fax | 229-382-4819
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Provider Business Mailing Address
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Address Line | PO BOX 1186
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City | TIFTON
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State | GA
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Zip | 31793-1186
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Country | US
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Telephone | 229-382-4765
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Fax | 229-382-4819
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TED A MCELROY
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Credential | OD
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Telephone | 229-382-4765
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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 | GA1397
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License Number State | GA
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