MEDICARE: DR. DONNA LEONNE 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	152WC0802X	Corneal and Contact Management Optometrist	OEG001054	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73236	OTHER	PA	AETNA
2	0530914000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	695858	OTHER	PW	PERSONAL CHOICE/ BLUE CHO

General Provider Information

NPI Number	:	1588629984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA LEONNE 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	:

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	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	02/28/2014

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