Ellis, Jerry H
Ellis, Jerry H is an sole proprietor health care provider with primary practice located at 197 Hospital Drive Suite A, Cherokee Village AR 72529-7315. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ellis, Jerry H can be contacted via phone (870) 257-2100.Contact Information
Primary practice address
197 Hospital Drive Suite A
Cherokee Village AR 72529-7315
Phone: (870) 257-2100
Fax: (870) 257-4395
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2408 | Arkansas |
Profile Details
| NPI number | 1083776611 |
|---|---|
| LBN Legal business name | Ellis, Jerry H |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 13th, 2006 |
| Last updated | Dec 7th, 2009 - about 16 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 | 1083776611 | NPPES |
| Arkansas | MEDICAID | 128855722 |
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