Organization
DANIEL O. ELLIOTT III OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL O ELLIOTT III OD (OWNER)
(574) 233-3617
Entity
Organization
Contact information
Practice address
220 N IRONWOOD DR, SOUTH BEND, IN 46615-2518
(574) 233-3617
(574) 280-7355
Mailing address
220 N IRONWOOD DR, SOUTH BEND, IN 46615-2518
(574) 233-3617
(574) 280-7355
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100221940A
—
IN
Enumeration date
03/06/2008
Last updated
07/21/2022
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