Provider Demographics
NPI:1932629755
Name:ELITE EYE CARE PLLC
Entity Type:Organization
Organization Name:ELITE EYE CARE PLLC
Other - Org Name:ELITE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-390-1315
Mailing Address - Street 1:4401 COLEMAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1371
Mailing Address - Country:US
Mailing Address - Phone:701-390-1315
Mailing Address - Fax:701-552-7171
Practice Address - Street 1:4401 COLEMAN ST STE 102
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1371
Practice Address - Country:US
Practice Address - Phone:701-390-1315
Practice Address - Fax:701-552-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty