Individual
DR. KEVIN MCELROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD, PA
Contact information
Practice address
50 E CARMEL DR, MERIDIAN, ID 83646-3301
(208) 888-5252
(208) 884-4280
Mailing address
50 E CARMEL DR, MERIDIAN, ID 83646-3301
(208) 888-5252
(208) 884-4280
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP653
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP653
ID
152WP0200X
Pediatric Optometrist
ODP653
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003410000
—
ID
01
—
721912
BLUE SHIELD
PA
01
—
82304
BLUE SHIELD
ID
01
—
V7169
BLUE CROSS / TRUE BLUE
ID
Enumeration date
10/04/2006
Last updated
02/25/2019
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