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General NPI Number Information
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NPI Number | 1689058919
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Entity Type | Individual
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Provider Name | ELNA MCGOWIN
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Gender | Female
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 27900 N MAIN ST STE 1
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City | DAPHNE
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State | AL
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Zip | 36526-7078
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Country | US
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Telephone | 251-621-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 27900N MAIN ST
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City | DAPHNE
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State | AL
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Zip | 36526-7077
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Country | US
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Telephone | 251-621-1211
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Fax | 251-621-9052
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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 | SD40
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License Number State | AL
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