Individual
DR. JOHN E ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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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