Individual
DR. ELLERY ISAAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4114 W MAPLE RD, BLOOMFIELD HILLS, MI 48301
(248) 539-4800
Mailing address
4114 W MAPLE RD, BLOOMFIELD HILLS, MI 48301-3000
(248) 539-4800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005069
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4901005069
—
MI
Enumeration date
06/26/2017
Last updated
07/15/2019
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