Individual
MR. JAMES ELLSWORTH HOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OCULARIST
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048E0
BLUE CROSS BLUE SHIELD OF NC
NC
01
—
260464169
TRI-CARE
NC
05
—
7705142
—
NC
Enumeration date
12/04/2006
Last updated
07/10/2013
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