Individual
DR. ROBERT ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
425 E 10TH ST, SUITE C, ANNISTON, AL 36207-4787
(256) 236-7516
Mailing address
425 E 10TH ST, SUITE C, ANNISTON, AL 36207-4787
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-A50-TA-640
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051520873
BCBS ANNISTON
AL
01
—
051520874
BCBS WOODLAND
AL
05
—
051554369
—
AL
Enumeration date
10/03/2006
Last updated
09/30/2010
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