Ellingson, Patrice C
Ellingson, Patrice C is an individual health care provider with primary practice located at 1515 E Paulding Rd , Fort Wayne IN 46816. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Ellingson, Patrice C can be contacted via phone (260) 744-2273.Contact Information
Primary practice address
1515 E Paulding Rd
Fort Wayne IN 46816
Phone: (260) 744-2273
Fax: (260) 744-4555
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18002448 | Indiana |
Profile Details
| NPI number | 1639163884 |
|---|---|
| LBN Legal business name | Ellingson, Patrice C |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 2nd, 2005 |
| Last updated | Aug 15th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639163884 | NPPES |
| Indiana | Other | 000000243494 | ANTHEM NONPAR |
| Indiana | MEDICAID | 100411890 | ANTHEM NONPAR |
| Indiana | MEDICAID | 100411890A | ANTHEM NONPAR |
| Indiana | Other | 410017027 | ANTHEM NONPAR |
| Indiana | Other | 410040819 | ANTHEM NONPAR |
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