Individual
OLIVIA MAE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO, ABOC
Contact information
Practice address
6819 WALTONS LN, GLOUCESTER, VA 23061-6113
(804) 693-2623
Mailing address
100 BURNT BRIDGE WAY APT E, YORKTOWN, VA 23692-4747
(757) 509-1655
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101004052
VA
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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