MEDICARE: DR ELLIOTT YOLLES PSC

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	207W00000X	Ophthalmology Physician	01025241A	IN
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104002815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ELLIOTT YOLLES PSC

Provider Business Mailing Address
First Line	:	2020 W 86TH ST
Second Line	:	SUITE 104
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1931
Country	:	US
Telephone Number	:	317-872-8772
Fax Number	:	317-872-2383

Provider Business Practice Location Address
First Line	:	2020 W 86TH ST
Second Line	:	SUITE 104
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1931
Country	:	US
Telephone Number	:	317-872-8772
Fax Number	:	317-872-2383

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. ELLIOTT A YOLLES
Credential	:	M.D.
Telephone Number	:	317-872-8772

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	05/03/2010

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Directions to “DR ELLIOTT YOLLES PSC ” Practice Location

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