Nicholas Ellis, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

2451 Issued in TN

Practice address

875 Union Street
Shelbyville, TN 37160

Phone

(931) 488-5778

NPI assigned

Feb 7, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cutting Edge Optical, LLC

  • Optician
  • Shelbyville, TN
  • NPI 1811608359
  NPD Authorized official

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1841996121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2672",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371622641",
            "telephone_number": "931-488-5778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 UNION STREET",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "37160",
            "telephone_number": "931-488-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NICHOLAS",
        "credential": "LDO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "TN",
            "license": "2451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Graham Edson
• Ginger Eisenga, BS
• Elite Health
• Elite Physical Therapy and Rehabilitation Services LLC
• Elite Physical Therapy and Rehabilitation, LLC
• Kimberly Micheline English, LCSW
• Kimberly Anne Epperson, CNA
• Essential Family Medicine, LLC
• Marilyn Everett, DC
• Eye Care Center Associates PA

• All providers in Shelbyville, TN
• Optician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.