MEDICARE: DR. JAMES WILLIAM ELLIOTT O.D.

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	152W00000X	Optometrist	926DT	KY

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	:	1174688097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WILLIAM ELLIOTT O.D.

Provider Business Mailing Address
First Line	:	12504 U.S. 60
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102
Country	:	US
Telephone Number	:	606-929-9432
Fax Number	:	606-929-9622

Provider Business Practice Location Address
First Line	:	10736 LAUREL RIDGE RD
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-8615
Country	:	US
Telephone Number	:	606-929-9432
Fax Number	:	606-929-9622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	05/31/2026

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