Ellington Eyecare PLLC
Organization Active NPI Optometrist · MC Cook, NE
NPI 1861130403 · NPPES record last updated Jul 10, 2022
Key facts
- NPI
- 1861130403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ELLINGTON EYECARE PLLC
- Practice address
- 1902 W B St
MC Cook, NE 69001-3579 - Phone
- (308) 345-1573
- NPI assigned
- May 24, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- ELLINGTON EYECARE PLLC
Authorized official
- Name
- Jacqueline Carmen Elizabeth Evans, OD
- Title
- Owner/President
- Phone
- (650) 278-7610
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 32
Practitioners 6
-
Sophia Moh, OD
-
Simran Sethi, O.D.
-
Abbey Elizabeth Studer, O.D.
-
Clayton Tyler Boyd, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220601002370 | NE | Part B Supplier - Clinic/Group Practice | 3072918754 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment Practice locations: MC Cook, NE; North Platte, NE |
National Provider Directory
- Tax ID family
- Ellington Eyecare PLLC
- Part of
- Ellington Eyecare PLLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1902 W B St
MC Cook, NE 69001-3579
Mailing address
4875 S Jason St
Englewood, CO 80110-6414
Phone (650) 278-7610
Other providers in MC Cook, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.