Individual
DR. GLEN W ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
250 FAME AVE STE 225, HANOVER, PA 17331-1576
(717) 637-1919
Mailing address
250 FAME AVE STE 225, HANOVER, PA 17331-1576
(717) 637-1919
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000289
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019476550006
—
PA
01
—
CG7940
RAILROAD MEDICARE
PA
Enumeration date
08/17/2005
Last updated
10/01/2024
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