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General NPI Number Information
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NPI Number | 1497429401
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Entity Type | Organization
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Legal Business Name | ELLINGTON EYECARE PLLC
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 200 W 136TH AVE
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City | WESTMINSTER
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State | CO
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Zip | 80234-1204
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Country | US
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Telephone | 720-929-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 4875 S JASON ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-6414
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Country | US
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Telephone | 650-278-7610
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JACQUELINE EVANS
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Credential | OD
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Telephone | 650-278-7610
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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 |
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License Number State |
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