Individual
MARY E ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
30 MEDICAL PARK, TOWER 3, SUITE 223, WHEELING, WV 26003-6391
(304) 243-7879
(304) 243-3901
Mailing address
30 MEDICAL PARK, TOWER 3, SUITE 223, WHEELING, WV 26003-6391
(304) 243-7879
(304) 243-3901
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
NON LICENSED STATE
WV
Other
Enumeration date
03/17/2008
Last updated
03/17/2008
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