Active NPI
Pedro L Ellin, OD
- Optometrist
- Manati, PR
National Provider Identifier
1780762237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 384
- Practice address
- 55 Paseo de la Atenas Ste 2
Manati, PR 00674-5169 - Phone
- (787) 854-2228
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 384 | PR | Primary |
Addresses
Primary practice location
55 Paseo de la Atenas Ste 2
Manati, PR 00674-5169
Mailing address
55 Paseo de la Atenas Ste 2
Manati, PR 00674-5169
Phone (787) 854-2228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081105000487 | PR | Practitioner - Optometry | 0648339622 | Practice locations: Manati, PR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 384 | PR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780762237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 PASEO DE LA ATENAS STE 2",
"city": "MANATI",
"state": "PR",
"postal_code": "006745169",
"telephone_number": "787-854-2228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 PASEO DE LA ATENAS STE 2",
"city": "MANATI",
"state": "PR",
"postal_code": "006745169",
"telephone_number": "787-854-2228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIN",
"first_name": "PEDRO",
"middle_name": "L",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PR",
"license": "384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manati, PR
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.