Healthcare Provider Details

I. General information

NPI: 1528852274
Provider Name (Legal Business Name): MADELYNN ELLIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MCLOUGHLIN BLVD
VANCOUVER WA
98663-3371
US

IV. Provider business mailing address

314 E MCLOUGHLIN BLVD
VANCOUVER WA
98663-3371
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-8303
  • Fax: 360-694-9032
Mailing address:
  • Phone: 360-694-8303
  • Fax: 360-694-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70155319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: