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General NPI Number Information
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NPI Number | 1831244938
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Entity Type | Organization
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Legal Business Name | ROBERT R. ELLISTON, M.D.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1750 EL CAMINO REAL SUIET 103
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City | BURLINGAME
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State | CA
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Zip | 94010-3228
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Country | US
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Telephone | 650-692-2020
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Fax | 650-692-1441
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Provider Business Mailing Address
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Address Line | 1750 EL CAMINO REAL SUIET 103
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City | BURLINGAME
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State | CA
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Zip | 94010-3228
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Country | US
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Telephone | 650-692-2020
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Fax | 650-692-1441
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT RICHARD ELLISTON
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Credential | M.D.
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Telephone | 650-692-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G23976
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License Number State | CA
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