NPIMap

Organization Active NPI

Elite Eyecare Associates, PC

Doing business as Ellis Family Eyecare

  • Optometrist
  • Sicklerville, NJ
National Provider Identifier
1083894943
Registry record updated Feb 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00505600 Issued in NJ
Legal business name
ELITE EYECARE ASSOCIATES, PC
Doing business as
Ellis Family Eyecare
Practice address
707 Liberty PL
Lakeside Business Park
Sicklerville, NJ 08081-5715
Phone
(185) 687-5002
Fax
(185) 651-3642
NPI assigned
Nov 8, 2007
Last updated
Feb 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Scot Ellis Sr., ODNPI 1871569244
Title
Optometric Physician
Phone
(856) 875-0022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 27OA00505600 NJ Primary

Addresses

Primary practice location

707 Liberty PL
Lakeside Business Park
Sicklerville, NJ 08081-5715

Mailing address

707 Liberty PL
Lakeside Business Park
Sicklerville, NJ 08081-5715
Phone (185) 687-5002

Other names 1

  • Ellis Family Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120120000168 NJ Part B Supplier - Clinic/Group Practice 5092982769 Receives reassigned benefits from 3 practitioners
Practice locations: Forked River, NJ; Little Egg Harbor TWP, NJ

National Provider Directory

National Provider Directory

Locations

707 Liberty Pl
Sicklerville, NJ 08081
Phone (856) 875-0022

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1083894943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 LIBERTY PL",
            "address_2": "LAKESIDE BUSINESS PARK",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815715",
            "telephone_number": "185-687-5002",
            "fax_number": "185-651-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 LIBERTY PL",
            "address_2": "LAKESIDE BUSINESS PARK",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815715",
            "telephone_number": "185-687-5002",
            "fax_number": "185-651-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE EYECARE ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SCOT",
        "authorized_official_title_or_position": "OPTOMETRIC PHYSICIAN",
        "authorized_official_telephone_number": "18568750022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00505600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellis Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sicklerville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.