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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 15 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 1083776611 NPPES
Arkansas MEDICAID 128855722

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