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General NPI Number Information
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NPI Number | 1174684401
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Entity Type | Individual
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Provider Name | JENNIFER ANN REGALADO-ELLIS O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9600 S. IH 35 SVS. RD., SB #S-225
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City | AUSTIN
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State | TX
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Zip | 78748
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Country | US
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Telephone | 512-291-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 312 RIM ROCK DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-8261
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Country | US
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Telephone | 512-863-5314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5341TG
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License Number State | TX
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