Ellingson Eyecare, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ELLINGSON EYECARE, INC.

Practice address

1451 Coral Ridge Ave Ste 518
Coralville, IA 52241-2805

Phone

(319) 466-0644

Fax

(319) 466-0330

NPI assigned

Jul 12, 2007

Organization subpart

No

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

Authorized official

Name

Larry D Ellingson, O.D.NPI 1831159169

Title

Owner

Phone

(319) 466-0644

Specialties & licenses 1

Addresses

Other identifiers 5

Practitioners 1

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

• Larry D. Ellingson, O.D.

  • Optometrist
  • Coralville, IA
  • NPI 1831159169
  NPD (past) Authorized official

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1467651372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 CORAL RIDGE AVE STE 518",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412805",
            "telephone_number": "319-466-0644",
            "fax_number": "319-466-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 CORAL RIDGE AVE STE 518",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412805",
            "telephone_number": "319-466-0644",
            "fax_number": "319-466-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGSON EYECARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "ELLINGSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-466-0644",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLAND'S CHOICE",
            "identifier": "244542",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "130740",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "25241",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259168",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS BLUE",
            "identifier": "45844",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Coralville, IA
• Providers in Coralville, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; 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.