Individual
DR. LARRY D. ELLINGSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1451 CORAL RIDGE AVE, CORALVILLE, IA 52241-2805
(319) 466-0644
(319) 466-0330
Mailing address
4823 RAPID CREEK RD NE, IOWA CITY, IA 52240-7716
(319) 643-2304
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
201431154
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1259168
—
IA
Enumeration date
03/23/2006
Last updated
01/06/2014
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