Provider Demographics
NPI:1023477106
Name:ELLIOTT VISION CARE, PLLC
Entity type:Organization
Organization Name:ELLIOTT VISION CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-272-8253
Mailing Address - Street 1:1139 N HILLS CTR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1882
Mailing Address - Country:US
Mailing Address - Phone:580-332-6000
Mailing Address - Fax:580-332-6006
Practice Address - Street 1:1139 N HILLS CTR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1882
Practice Address - Country:US
Practice Address - Phone:580-332-6000
Practice Address - Fax:580-332-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty