Individual
DR. PETER J ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
701 W BROAD ST, FALLS CHURCH, VA 22046-3220
(703) 237-6500
(703) 237-6504
Mailing address
701 W BROAD ST, FALLS CHURCH, VA 22046-3220
(703) 237-6500
(703) 237-6504
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000422
VA
Other
Enumeration date
07/15/2008
Last updated
07/15/2008
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