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General NPI Number Information
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NPI Number | 1932351681
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Entity Type | Organization
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Legal Business Name | PLAZA OPTOMETRISTS INC.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 3018 STATE ROUTE 5 SUITE C
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City | CORTLAND
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State | OH
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Zip | 44410-9178
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Country | US
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Telephone | 330-638-4097
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Fax | 330-637-0140
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Provider Business Mailing Address
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Address Line | 20 W FEDERAL ST SUITE T 4
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City | YOUNGSTOWN
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State | OH
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Zip | 44503-1420
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Country | US
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Telephone | 330-638-4097
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Fax | 330-637-0140
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN G. ELLIS
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Credential | O.D.
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Telephone | 330-638-4097
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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 | 3343 T420
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License Number State | OH
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