Provider Demographics
NPI:1609971126
Name:ELLIS, FORREST J (MD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:J
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6231 LEESBURG PIKE STE 608
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2102
Mailing Address - Country:US
Mailing Address - Phone:703-534-3900
Mailing Address - Fax:703-536-3729
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:SUITE 608
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-534-3900
Practice Address - Fax:703-536-3729
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101241653207WX0110X, 207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48984Medicare UPIN