NPIMap

Organization Active NPI

Ellington Eyecare PLLC

  • Optometrist
  • Westminster, CO
National Provider Identifier
1497429401
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ELLINGTON EYECARE PLLC
Practice address
200 W 136TH Ave
Westminster, CO 80234-1204
Phone
(720) 929-1776
NPI assigned
Aug 3, 2021
Organization subpart
Yes
Parent organization
ELLINGTON EYECARE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Authorized official

Name
Jacqueline Evans, ODNPI 1053726315
Title
Owner/President
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

200 W 136TH Ave
Westminster, CO 80234-1204

Mailing address

4875 S Jason St
Englewood, CO 80110-6414
Phone (650) 278-7610

Other identifiers 1

IdentifierTypeStateIssuer
1053726315MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210818001344 CO Part B Supplier - Clinic/Group Practice 3072918754 Receives reassigned benefits from 6 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Junta, CO; Westminster, CO; Pueblo, CO; Lone Tree, CO; Gypsum, CO; Denver, CO; Colorado Springs, CO; Aurora, CO…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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

Locations

3201 E Platte Ave
Colorado Springs, CO 80909
Phone (719) 578-0380

7805 E 35th Ave
Denver, CO 80238
Phone (720) 941-7146

7817 Park Meadows Dr
Lone Tree, CO 80124
Phone (303) 662-1720

13164 Garrett Hwy
Oakland, MD 21550
Phone (301) 334-9129

120 Ajk Blvd
Lewisburg, PA 17837
Phone (570) 522-8200

Practitioners & affiliated clinicians

Practitioners 5

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": "1627948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1497429401",
    "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",
            "telephone_number": "650-278-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W 136TH AVE",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802341204",
            "telephone_number": "720-929-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGTON EYECARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLINGTON EYECARE PLLC",
        "enumeration_date": "2021-08-03",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053726315",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.