Organization
ELLEN L. ELLSWORTH, OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN LILLE ELLSWORTH O.D. (PRESIDENT)
(440) 352-8031
Entity
Organization
Contact information
Practice address
9930 JOHNNYCAKE RIDGE RD, SUITE 4B, MENTOR, OH 44060-6752
(440) 352-8031
(440) 352-7671
Mailing address
9930 JOHNNYCAKE RIDGE RD, SUITE 4B, MENTOR, OH 44060-6752
(440) 352-8031
(440) 352-7671
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4277 T228
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0841316
—
OH
Enumeration date
11/03/2007
Last updated
07/02/2008
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