Provider Demographics
NPI:1174648869
Name:ELLIS, ARVEYETTE (OD)
Entity Type:Individual
Prefix:
First Name:ARVEYETTE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7250
Mailing Address - Country:US
Mailing Address - Phone:804-276-9014
Mailing Address - Fax:
Practice Address - Street 1:7104 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5501
Practice Address - Country:US
Practice Address - Phone:804-276-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA18226001OtherDAVIS VISION
VAVA1456OtherEYEMED
VA19476OtherAVESIS