Organization
ELLINGTON OPTICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES EDWARD ELLINGTON JR. (OWNEROPTICIAN)
(804) 526-6119
Entity
Organization
Contact information
Practice address
201 TEMPLE AVE, B, COLONIAL HEIGHTS, VA 23834-2801
(804) 526-6119
(804) 526-0166
Mailing address
201 TEMPLE AVE, B, COLONIAL HEIGHTS, VA 23834-2801
(804) 526-6119
(804) 526-0166
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
585
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11663464
CAQH PROVIDER ID
VA
01
—
BCBS
BCBS PROVIDER #
VA
Enumeration date
12/13/2006
Last updated
10/17/2007
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