Individual
DR. MICHAEL SCOTT ELLENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1601 MOUNT RUSHMORE RD, SUITE 5, RAPID CITY, SD 57701-4588
(605) 348-7401
(605) 348-9773
Mailing address
1601 MOUNT RUSHMORE RD, SUITE 5, RAPID CITY, SD 57701-4588
(605) 348-7401
(605) 348-9773
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T573
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9201210
—
SD
Enumeration date
11/13/2006
Last updated
10/04/2007
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