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NPI Code Detail

MEDICARE: ELLINGTON EYECARE PLLC

MEDICARE: ELLINGTON EYECARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1306683305
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLINGTON EYECARE PLLC
Provider Business Mailing Address
First Line : 4875 S JASON ST
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80110-6414
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 WALMART DR
Second Line :
City : EATONTON
State : GA
Zip : 31024-6761
Country : US
Telephone Number : 706-485-7955
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JACQUELINE CARMEN ELIZABETH EVANS
Credential : OD
Telephone Number : 650-278-7610
Provider Enumeration Date : 07/09/2024
Last Update Date : 04/10/2026

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