Provider Demographics
NPI:1538246111
Name:ELLIOT, NEIL G (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:G
Last Name:ELLIOT
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 1:20449 STATE ROAD 7
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6776
Mailing Address - Country:US
Mailing Address - Phone:561-487-2777
Mailing Address - Fax:561-482-3247
Practice Address - Street 1:20449 STATE ROAD 7
Practice Address - Street 2:SUITE A-4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6776
Practice Address - Country:US
Practice Address - Phone:561-487-2777
Practice Address - Fax:561-482-3247
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19466OtherMEDICARE B
FL19466OtherMEDICARE B
FL0553330001Medicare NSC