Provider Demographics
NPI:1407097413
Name:DARREN ELG, O D LLC
Entity type:Organization
Organization Name:DARREN ELG, O D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-987-3400
Mailing Address - Street 1:20715 E OCOTILLO RD
Mailing Address - Street 2:STE 101
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6118
Mailing Address - Country:US
Mailing Address - Phone:480-987-3400
Mailing Address - Fax:
Practice Address - Street 1:20715 E OCOTILLO RD
Practice Address - Street 2:STE 101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6118
Practice Address - Country:US
Practice Address - Phone:480-987-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619265Medicaid
AZ619265Medicaid
AZ4400520001Medicare NSC
AZZ64877Medicare PIN