Provider Demographics
NPI:1396958716
Name:HO, ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:HO
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 1:13537 HICKORY GLEN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6705
Mailing Address - Country:US
Mailing Address - Phone:804-796-9726
Mailing Address - Fax:
Practice Address - Street 1:13537 HICKORY GLEN RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-6705
Practice Address - Country:US
Practice Address - Phone:804-796-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9231048Medicaid
VAU78153Medicare UPIN
VA410001177Medicare ID - Type Unspecified