Individual
DR. CLINTON ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-4951
(208) 529-6600
(208) 529-6602
Mailing address
2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404-4951
(208) 529-6600
(208) 529-6600
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01080410A
IN
207W00000X
Ophthalmology Physician
49026
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
49026
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
M-15285
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160321
—
OH
05
—
1326332776
—
ID
05
—
1326332776
—
WV
05
—
300021246
—
IN
05
—
7100279250
—
KY
Enumeration date
06/02/2011
Last updated
09/16/2025
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