Individual
JESSICA ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60394843
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12252261
CAQH PROVIDER ID
PA
Enumeration date
08/01/2011
Last updated
09/22/2015
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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