Provider Demographics
NPI:1053598904
Name:ELLIS' FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:ELLIS' FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-294-8144
Mailing Address - Street 1:691 ROUTE 9 S
Mailing Address - Street 2:MILLERS MALL, UNIT 4
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4020
Mailing Address - Country:US
Mailing Address - Phone:609-294-8144
Mailing Address - Fax:609-512-5190
Practice Address - Street 1:691 ROUTE 9 S
Practice Address - Street 2:MILLERS MALL, UNIT 4
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-4020
Practice Address - Country:US
Practice Address - Phone:609-294-8144
Practice Address - Fax:609-512-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA05056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124542OtherPTAN