Individual
DR. ROBERT RICHARD ELLISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1750 EL CAMINO REAL, STE 103, BURLINGAME, CA 94010-3210
(650) 692-2020
(650) 692-1441
Mailing address
1750 EL CAMINO REAL, STE 103, BURLINGAME, CA 94010-3210
(650) 692-2020
(650) 692-1441
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G23976
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G23976
STATE MEDICAL LICENSE
CA
Enumeration date
05/28/2005
Last updated
03/07/2023
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