Healthcare Provider Details

I. General information

NPI: 1194632984
Provider Name (Legal Business Name): ELLINGTON EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 120TH AVE
THORNTON CO
80233-5711
US

IV. Provider business mailing address

4875 S JASON ST
ENGLEWOOD CO
80110-6414
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-0971
  • Fax:
Mailing address:
  • Phone:
  • 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: OPTOMETRIST
Credential:
Phone: 303-445-9446