MEDICARE: DR. RUSSELL PRICE 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	18001535A	IN

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	:	1588642276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL PRICE ELLIOTT O.D.

Provider Business Mailing Address
First Line	:	125 E WASHINGTON ST
Second Line	:	PO BOX 565
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-1511
Country	:	US
Telephone Number	:	765-653-3914
Fax Number	:	765-653-7237

Provider Business Practice Location Address
First Line	:	125 E WASHINGTON ST
Second Line	:
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-1511
Country	:	US
Telephone Number	:	765-653-3914
Fax Number	:	765-653-7237

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	01/12/2026

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