Individual
JERRY N ELLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
560 DABNEY DRIVE, HENDERSON, NC 27536
(252) 438-6132
(252) 438-5161
Mailing address
560 DABNEY DRIVE, HENDERSON, NC 27536
(252) 438-6132
(252) 438-5161
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1455
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8909180
—
NC
05
—
890920F
—
NC
Enumeration date
07/10/2006
Last updated
01/11/2013
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