Provider Demographics
NPI:1306904107
Name:ELLIOTT, STEVEN D (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 MAYNARDVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5348
Mailing Address - Country:US
Mailing Address - Phone:865-922-3937
Mailing Address - Fax:865-922-8412
Practice Address - Street 1:6719 MAYNARDVILLE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5348
Practice Address - Country:US
Practice Address - Phone:865-922-3937
Practice Address - Fax:865-922-8412
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT-OD-2347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4595260002OtherPTAN FOR FOUNTAIN CITY EYECARE
TN3945379Medicaid
TN4595260001OtherPTAN FOR ELLIOTT EYECARE CENTER
TNU91310Medicare UPIN
TN4595260001OtherPTAN FOR ELLIOTT EYECARE CENTER
TN3945379Medicare ID - Type UnspecifiedDR ELLIOTT-ELLIOTT EYECAR