NPIMap

Organization Active NPI

Ellington Eyecare PLLC

  • Optometrist
  • Palm Bay, FL
National Provider Identifier
1710608302
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
1040 Malabar Rd SE
Palm Bay, FL 32907-3251
Phone
(321) 723-2031
NPI assigned
Sep 12, 2022
Last updated
Sep 12, 2022By the provider in NPPES
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 Carmen Elizabeth 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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1040 Malabar Rd SE
Palm Bay, FL 32907-3251

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Ellington Eyecare PLLC34 organizations share this tax ID, including this one
Part of
Ellington Eyecare PLLC

Other organizations with this tax ID 33

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

View all 33

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1710608302",
    "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": "1040 MALABAR RD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073251",
            "telephone_number": "321-723-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGTON EYECARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLINGTON EYECARE PLLC",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "CARMEN ELIZABETH",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "650-278-7610",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.