Provider Demographics
NPI:1811074230
Name:MCELVEEN, KAREN (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:MCELVEEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VERDAE BLVD STE 160
Mailing Address - Street 2:VERDAE MARKET FAIR
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3836
Mailing Address - Country:US
Mailing Address - Phone:864-676-1123
Mailing Address - Fax:864-675-3835
Practice Address - Street 1:101 VERDAE BLVD STE 160
Practice Address - Street 2:VERDAE MARKET FAIR
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3836
Practice Address - Country:US
Practice Address - Phone:864-676-1123
Practice Address - Fax:864-675-3835
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9957Medicaid
SCSC0770OtherEYEMED
SCSC0770OtherEYEMED
SCT66337Medicare UPIN