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Individual

DR. ROBERT E. ELLIOTT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
2722 OLD MILL DR, RACINE, WI 53405-1320
(262) 632-2020
(262) 632-7085
Mailing address
2722 OLD MILL DR, RACINE, WI 53405-1320
(262) 632-2020
(262) 632-7085

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2658
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38620900
WI
Enumeration date
01/04/2006
Last updated
07/21/2022
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