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General NPI Number Information
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NPI Number | 1558468447
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Entity Type | Individual
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Provider Name | ELLYN M LOVETT O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 851 EASTPORT CENTRE DR
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City | VALPARAISO
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State | IN
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Zip | 46383-2909
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Country | US
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Telephone | 219-464-8223
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Fax | 219-531-2356
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Provider Business Mailing Address
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Address Line | 752 WOOD STREAM XING
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City | VALPARAISO
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State | IN
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Zip | 46385-2972
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Country | US
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Telephone | 219-476-0343
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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 | 18002888
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License Number State | IN
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