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General NPI Number Information
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NPI Number | 1699560169
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Entity Type | Individual
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Provider Name | JEFFNA ELAVUMKAL OD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 9916 75TH ST STE 101
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City | KENOSHA
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State | WI
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Zip | 53142-7583
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Country | US
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Telephone | 262-658-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 92 ASHLAND AVE
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City | DES PLAINES
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State | IL
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Zip | 60016-6118
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Country | US
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Telephone | 224-703-0062
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4071-35
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License Number State | WI
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