Organization
ELLEN L. ELLSWORTH, OD INC
Active
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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