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Individual

DR. JOHN S ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
691 ROUTE 9 S, MILLERS MALL - UNIT 4, LITTLE EGG HARBOR TWP, NJ 08087-4020
(609) 294-8144
(609) 812-5190
Mailing address
691 ROUTE 9 S, MILLERS MALL - UNIT 4, LITTLE EGG HARBOR TWP, NJ 08087-4020
(609) 294-8144
(609) 812-5190

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OA05056
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
630717YCT
MEDICARE PTAN
NJ
Enumeration date
02/27/2006
Last updated
02/10/2012
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