Individual
DR. JOHN E ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
619 E CRAWFORD AVE, CONNELLSVILLE, PA 15425-2102
(724) 628-1370
(724) 628-7314
Mailing address
619 E CRAWFORD AVE, CONNELLSVILLE, PA 15425-2102
(724) 628-1370
(724) 628-7314
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001091
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009205
DORAL
PA
05
—
0014138740003
—
PA
01
—
03770
GATEWAY
PA
01
—
118173
UNISON
PA
01
—
123681
AETNA
PA
01
—
137989
EYEMED
PA
01
—
1451095
UMWA
PA
01
—
207741
UPMC
PA
01
—
397414
ADVANTRA
PA
01
—
EL715656
PA BLUE SHIELD
—
01
—
P00230647
UNITED HEALTHCARE
PA
Enumeration date
04/10/2006
Last updated
03/05/2014
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