NPIMap

Organization Active NPI

Trumbull Optical Assc. Inc

Doing business as Martin G. Ellis O.D.

  • Optometrist
  • Cortland, OH
National Provider Identifier
1740481100
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TRUMBULL OPTICAL ASSC. INC
Doing business as
Martin G. Ellis O.D.
Practice address
3018 State Route 5 Ste C
Cortland, OH 44410-9236
Phone
(330) 638-4097
NPI assigned
May 31, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Martin G. Ellis, O.D.NPI 1871664391
Title
Owner
Phone
(330) 638-4097

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

3018 State Route 5 Ste C
Cortland, OH 44410-9236

Mailing address

3018 State Route 5 Ste C
Cortland, OH 44410-9236
Phone (330) 638-4097

Other identifiers 1

IdentifierTypeStateIssuer
0373359MedicaidOH

Other names 1

  • MARTIN G. ELLIS O.D. Doing business as

National Provider Directory

National Provider Directory

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": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740481100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3018 STATE ROUTE 5 STE C",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444109236",
            "telephone_number": "330-638-4097",
            "fax_number": "330-637-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3018 STATE ROUTE 5 STE C",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444109236",
            "telephone_number": "330-638-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMBULL OPTICAL ASSC. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-638-4097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "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": "0373359",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN G. ELLIS O.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cortland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.