Individual
DR. JEFFERY DALE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1139 N HILLS CTR, ADA, OK 74820-1882
(580) 332-6000
(580) 332-6006
Mailing address
1139 N HILLS CTR, ADA, OK 74820-1882
(580) 332-6000
(580) 332-6006
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2241
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100762790A
—
OK
Enumeration date
10/20/2006
Last updated
01/17/2022
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