Individual
DR. JOHN L ELLIS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3800 N MESA, STE C8, EL PASO, TX 79902
(915) 533-1811
(915) 533-3641
Mailing address
3800 N MESA ST, STE B1, EL PASO, TX 79902-1535
(915) 533-1811
(915) 533-3641
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5395T6
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06654720
MEDICAID
NM
01
—
143852
COLE VISION
—
05
—
160390401
—
TX
01
—
4722920001
MEDICARE PALMETTO
—
01
—
5395
EYEMED VISION
TX
01
—
807829
BLUE CROSS BLUE SHIELD
TX
01
—
914210
BLOCK VISION
—
01
—
P00113768
MEDICARE RAILROAD
—
Enumeration date
10/21/2005
Last updated
10/20/2016
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