Individual
DR. JOE E ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
109 W 5TH ST, BENTON, KY 42025-1123
(270) 527-7421
(270) 527-3118
Mailing address
PO BOX 256, BENTON, KY 42025-0256
(270) 527-7421
(270) 527-3118
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1073DT
KY
174400000X
Specialist
1073DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000053519
BLUE CROSS BLUE SHIELD
KY
01
—
149794
HEALTHLINK
KY
01
—
4349131
AETNA
KY
05
—
77010734
—
KY
01
—
T54572
BLUEGRASS FAMILY HEALTH
KY
Enumeration date
02/16/2006
Last updated
03/07/2023
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