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
Fax: (260) 744-4555
Website:

Health care specialties

SpecialtyCodeLicense #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 6 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.

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Identifiers

StateTypeNumberIssuer
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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