Provider Demographics
NPI:1558498535
Name:ELLINGER, DONNA M (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:CHEN ELLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO009184OtherKAISER-COMMERCIAL NUMBER
CO08015901Medicaid
CO08015901Medicaid
CO009184OtherKAISER-COMMERCIAL NUMBER
COCK10892Medicare PIN