NPIMap

Organization Active NPI

Ellington Eyecare PLLC

  • Optometrist
  • Middleburg, FL
National Provider Identifier
1245077262
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ELLINGTON EYECARE PLLC
Practice address
1580 Branan Field Rd
Middleburg, FL 32068-8427
Phone
(904) 214-9102
NPI assigned
Jul 9, 2024
Organization subpart
Yes
Parent organization
ELLINGTON EYECARE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Jacqueline Carmen Elizabeth Evans, ODNPI 1053726315
Title
Owner
Phone
(650) 278-7610

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 Primary

Addresses

Primary practice location

1580 Branan Field Rd
Middleburg, FL 32068-8427

Mailing address

4875 S Jason St
Englewood, CO 80110-6414

National Provider Directory

National Provider Directory
Tax ID family
Ellington Eyecare PLLC33 organizations share this tax ID, including this one
Part of
Ellington Eyecare PLLC

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1245077262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4875 S JASON ST",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801106414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 BRANAN FIELD RD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320688427",
            "telephone_number": "904-214-9102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGTON EYECARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLINGTON EYECARE PLLC",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "CARMEN ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-278-7610",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.