Glenn D Ellisor, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

03337TG Issued in TX

Practice address

1714 Kingwood Dr
Kingwood, TX 77339-3046

Phone

(281) 359-2020

Fax

(281) 359-7019

NPI assigned

Jan 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Houston - College of Optometry, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vision Source - Kingwood, PAGroup PAC ID 9638152267, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vision Source - Kingwood, PA

  • Optometrist
  • Kingwood, TX
  • NPI 1265564769
  Medicare reassignment Care Compare group NPD Authorized official
• Vision Source - Atascocita, P.a.

  • Optometrist
  • Humble, TX
  • NPI 1457308306
  NPD

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407900590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 GOLDEN POND DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773451636",
            "telephone_number": "281-359-2020",
            "fax_number": "281-359-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 KINGWOOD DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773393046",
            "telephone_number": "281-359-2020",
            "fax_number": "281-359-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISOR",
        "first_name": "GLENN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "03337TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "81071Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellett Medical Supplies Inc (Ellett Medical Consulting)
• Kim Elliott, MD
• Wanda Elliott, LSA
• Danya Ellis, M.D.
• Erin C Ellisor, OD
• Wade Ellisor, OD
• Jaleesa Elwin
• Ojomah Angela Emono, M.D.
• Empathetic Insights Counseling and Supervision, PLLC
• Empowered Psychological Services, PLLC

• Corneal and Contact Management Optometrist in Kingwood, TX
• Providers in Kingwood, TX by specialty
• Corneal and Contact Management Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.