MEDICARE: DR. JEREMY ELMORE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	18003454	IN
2	152WP0200X	Pediatric Optometrist	18003454	IN
3	152WS0006X	Sports Vision Optometrist	18003454	IN
4	152WV0400X	Vision Therapy Optometrist	18003454	IN
5	152WX0102X	Occupational Vision Optometrist	18003454	IN
6	152W00000X	Optometrist	18003454	IN

General Provider Information

NPI Number	:	1043453509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JEREMY ELMORE INC.

Provider Business Mailing Address
First Line	:	1352 ECHO BEND ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1119
Country	:	US
Telephone Number	:	317-908-8548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3719 SOUT EAST STREET
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1290
Country	:	US
Telephone Number	:	317-908-8548
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY ELMORE
Credential	:	O.D.
Telephone Number	:	317-908-8548

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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