Individual provider Active NPI

Ellen Ren, O.D.

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1912685256
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG004020 Issued in PA
Practice address
1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone
(215) 276-6000
Fax
(215) 276-6096
NPI assigned
Jul 7, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG004020 PA Primary

Addresses

Primary practice location

1200 W Godfrey Ave
Philadelphia, PA 19141-3323

Mailing address

1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone (215) 276-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241216002982 NY Practitioner - Optometry 2062874233 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OEG004020PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pennsylvania College of Optometry Optometrist Current Accepting new patients
Sophia Siu M.D. PLLC CurrentSince Nov 1, 2024 Accepting new patients
Ronald C. Huang M.D. LLC CurrentSince Sep 5, 2021 Accepting new patients

Locations

3701 Main St
Ste 2
Flushing, NY 11354
Phone (718) 808-8181

1200 W Godfrey Ave
Philadelphia, PA 19141
Phone (215) 276-6000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1912685256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-6096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REN",
        "first_name": "ELLEN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG004020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.