Provider Demographics
NPI:1437483906
Name:ELLIS, BRITTANY (OD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
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 1:141 W HARBOR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3558
Mailing Address - Country:US
Mailing Address - Phone:614-323-4160
Mailing Address - Fax:
Practice Address - Street 1:2204 CRESTMOOR RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2002
Practice Address - Country:US
Practice Address - Phone:615-327-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2809152W00000X
OH5857152W00000X
TN3780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5857OtherOPTOMETRY LICENSE
OK2809OtherOPTOMETRY LICENSE
TN3780OtherOPTOMETRY LICENSE
OHT2771OtherTHERAPEUTIC CERTIFICATE