MEDICARE: DONNA L. ELCOCK, 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	OEG001054	PA

General Provider Information

NPI Number	:	1528200318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNA L. ELCOCK, O.D.

Provider Business Mailing Address
First Line	:	538 CHURCH LN
Second Line	:
City	:	YEADON
State	:	PA
Zip	:	19050-3102
Country	:	US
Telephone Number	:	610-284-0777
Fax Number	:	610-284-2808

Provider Business Practice Location Address
First Line	:	538 CHURCH LN
Second Line	:
City	:	YEADON
State	:	PA
Zip	:	19050-3102
Country	:	US
Telephone Number	:	610-284-0777
Fax Number	:	610-284-2808

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DONNA L. ELCOCK
Credential	:	O.D.
Telephone Number	:	610-284-0777

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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