Provider Demographics
NPI:1083894943
Name:ELITE EYECARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:ELITE EYECARE ASSOCIATES, PC
Other - Org Name:ELLIS FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:1856-875-0022
Mailing Address - Street 1:707 LIBERTY PL
Mailing Address - Street 2:LAKESIDE BUSINESS PARK
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5715
Mailing Address - Country:US
Mailing Address - Phone:185-687-5002
Mailing Address - Fax:185-651-3642
Practice Address - Street 1:707 LIBERTY PL
Practice Address - Street 2:LAKESIDE BUSINESS PARK
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5715
Practice Address - Country:US
Practice Address - Phone:185-687-5002
Practice Address - Fax:185-651-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00505600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ232901Medicare PIN