Active NPI
Daniel Adam Ellis, L.D.O.
- Optician
- Spokane, WA
National Provider Identifier
1174886220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- DO-00000549
- Practice address
- N. 1804 Washington
Ye Olde Optical Shoppe
Spokane, WA 99205-4757 - Phone
- (509) 326-3459
- Fax
- (509) 326-3459
- NPI assigned
- Jun 22, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | DO-00000549 | WA | Primary |
Addresses
Primary practice location
N. 1804 Washington
Ye Olde Optical Shoppe
Spokane, WA 99205-4757
Mailing address
N. 1804 Washington
Ye Olde Optical Shoppe
Spokane, WA 99205-4757
Phone (509) 326-3459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO-00000549 | WA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1174886220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N. 1804 WASHINGTON",
"address_2": "YE OLDE OPTICAL SHOPPE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992054757",
"telephone_number": "509-326-3459",
"fax_number": "509-326-3459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N. 1804 WASHINGTON",
"address_2": "YE OLDE OPTICAL SHOPPE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992054757",
"telephone_number": "509-326-3459",
"fax_number": "509-326-3459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DANIEL",
"middle_name": "ADAM",
"name_prefix": "Mr.",
"credential": "L.D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-22",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "WA",
"license": "DO-00000549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.