Provider Demographics
NPI:1275254864
Name:ELLINGTON EYECARE PLLC
Entity Type:Organization
Organization Name:ELLINGTON EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:CARMEN ELIZABETH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-278-7610
Mailing Address - Street 1:4875 S JASON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6414
Mailing Address - Country:US
Mailing Address - Phone:650-278-7610
Mailing Address - Fax:
Practice Address - Street 1:2931 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-8607
Practice Address - Country:US
Practice Address - Phone:941-475-3374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLINGTON EYECARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty