Provider Demographics
NPI:1811000367
Name:PATOUNAS, ELLIE K (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:K
Last Name:PATOUNAS
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 1:1 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1603
Mailing Address - Country:US
Mailing Address - Phone:609-203-6413
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2500
Practice Address - Country:US
Practice Address - Phone:732-462-8707
Practice Address - Fax:732-780-3699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007038152W00000X
PAOEG003361152W00000X
NJ27OA00610100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6783482OtherAETNA HMO
NJ7183855OtherAETNA PPO
NJ120294CJPMedicare PIN