Provider Demographics
NPI:1902089428
Name:DR. ELM AND ASSOCIATES INC.
Entity Type:Organization
Organization Name:DR. ELM AND ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ELM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-496-9699
Mailing Address - Street 1:2811 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5748
Mailing Address - Country:US
Mailing Address - Phone:920-496-9699
Mailing Address - Fax:920-496-1540
Practice Address - Street 1:2811 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5748
Practice Address - Country:US
Practice Address - Phone:920-496-9699
Practice Address - Fax:920-496-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2363OtherSTATE LICENSE
WI2363OtherSTATE LICENSE