Provider Demographics
NPI:1609569334
Name:SCHULZ, ELLI ROBBIN (DO61230218)
Entity Type:Individual
Prefix:
First Name:ELLI
Middle Name:ROBBIN
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:DO61230218
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3411 E KOLONELS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9089
Mailing Address - Country:US
Mailing Address - Phone:360-452-6131
Mailing Address - Fax:360-452-9535
Practice Address - Street 1:3411 E KOLONELS WAY
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9089
Practice Address - Country:US
Practice Address - Phone:360-452-6131
Practice Address - Fax:360-452-9535
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO61230218156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician