MEDICARE: DR. RITA ELLENT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VUT005856	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49890	OTHER	NY	DAVIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649278953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA ELLENT O.D.

Provider Business Mailing Address
First Line	:	12 STATION SQ
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5234
Country	:	US
Telephone Number	:	917-803-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	8325 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7320
Country	:	US
Telephone Number	:	718-426-2725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/17/2013

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