NPIMap

Organization Active NPI

Ellington Eyecare PLLC

  • Optometrist
  • Saint Clair, PA
National Provider Identifier
1790400893
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ELLINGTON EYECARE PLLC
Practice address
500 Terry Rich Blvd
Saint Clair, PA 17970-1090
Phone
(570) 429-2650
NPI assigned
Oct 11, 2022
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ELLINGTON EYECARE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Authorized official

Name
Jacqueline Carmen Elizabeth Evans, O.DNPI 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 Primary

Addresses

Primary practice location

500 Terry Rich Blvd
Saint Clair, PA 17970-1090

Mailing address

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

Other practice location 1

120 Ajk Blvd
Lewisburg, PA 17837-7491
Phone (570) 522-8224

Other practice location 2

500 Gallery Blvd
Scarborough, ME 04074-6606
Phone (207) 885-5567

Other practice location 3

100 Mount Auburn Ave
Auburn, ME 04210-8651
Phone (207) 784-0738

Other practice location 4

781 Main St
Presque Isle, ME 04769-2201
Phone (207) 764-8485

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240703002109 PA Part B Supplier - Clinic/Group Practice 3072918754 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewisburg, PA; New Castle, PA; Saint Clair, PA; Harrisburg, PA

Other NPIs on the same Medicare enrollment 3

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

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

Locations

100 Mount Auburn Ave
Auburn, ME 04210
Phone (207) 753-0800

Practitioners & affiliated clinicians

Practitioners 2

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": "1665446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1790400893",
    "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": "500 TERRY RICH BLVD",
            "city": "SAINT CLAIR",
            "state": "PA",
            "postal_code": "179701090",
            "telephone_number": "570-429-2650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Ajk Blvd",
            "address_purpose": "LOCATION",
            "city": "Lewisburg",
            "state": "PA",
            "postal_code": "178377491",
            "country_code": "US",
            "telephone_number": "570-522-8224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Gallery Blvd",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040746606",
            "country_code": "US",
            "telephone_number": "207-885-5567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Mount Auburn Ave",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "ME",
            "postal_code": "042108651",
            "country_code": "US",
            "telephone_number": "207-784-0738",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "781 Main St",
            "address_purpose": "LOCATION",
            "city": "Presque Isle",
            "state": "ME",
            "postal_code": "047692201",
            "country_code": "US",
            "telephone_number": "207-764-8485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELLINGTON EYECARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLINGTON EYECARE PLLC",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "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": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.