Provider Demographics
NPI:1356835748
Name:ELLINGSON, EMILY (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8401 GOLDEN VALLEY RD STE 330
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4687
Mailing Address - Country:US
Mailing Address - Phone:952-416-7600
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:8501 GOLDEN VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4472
Practice Address - Country:US
Practice Address - Phone:763-416-7600
Practice Address - Fax:763-416-7634
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist