Healthcare Provider Details

I. General information

NPI: 1073445482
Provider Name (Legal Business Name): ELLINGTON EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 STAFFORD LN
DELTA CO
81416-3465
US

IV. Provider business mailing address

4875 S JASON ST
ENGLEWOOD CO
80110-6414
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-1585
  • Fax:
Mailing address:
  • Phone: 970-874-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE CARMEN ELIZABETH EVANS
Title or Position: CEO
Credential: O.D
Phone: 303-445-9446