Provider Demographics
NPI:1619143013
Name:DR. JOHN ELY
Entity Type:Organization
Organization Name:DR. JOHN ELY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-635-3223
Mailing Address - Street 1:869C JOHN MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4578
Mailing Address - Country:US
Mailing Address - Phone:540-635-3223
Mailing Address - Fax:540-635-1050
Practice Address - Street 1:869C JOHN MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4578
Practice Address - Country:US
Practice Address - Phone:540-635-3223
Practice Address - Fax:540-635-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0661670001Medicare NSC