Provider Demographics
NPI:1881751055
Name:GANSKE-MORRILL, ELLEN MARY (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARY
Last Name:GANSKE-MORRILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:MARY
Other - Last Name:GANSKE-MORRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2155 IRON POINT RD
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8632T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist