Provider Demographics
NPI:1699972968
Name:ELMORE, JEREMY ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALLEN
Last Name:ELMORE
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 1:1352 ECHO BEND ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1119
Mailing Address - Country:US
Mailing Address - Phone:317-908-8548
Mailing Address - Fax:
Practice Address - Street 1:735 WHITFIELD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2611
Practice Address - Country:US
Practice Address - Phone:812-375-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003454A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist