MEDICARE: DR. DOUGLAS RICHARD ELEY OD

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	3778TG	TX

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	:	1316989031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS RICHARD ELEY OD

Provider Business Mailing Address
First Line	:	9009 GATEWAY BLVD S
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-1215
Country	:	US
Telephone Number	:	915-751-7760
Fax Number	:	915-751-2376

Provider Business Practice Location Address
First Line	:	9009 GATEWAY BLVD S
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-1215
Country	:	US
Telephone Number	:	915-751-7760
Fax Number	:	915-751-2376

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	12/03/2007

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