Dr. Timothy J. Ellis, O.D.
Optometrist in Boise, ID. Individual provider (NPI-1).
NPI number1285644856
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1285644856
- Entity type
- Individual (NPI-1)
- Name
- Dr. Timothy J. Ellis
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 8, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 0882 | ID | Yes |
Practice location
500 W Fort StBoise, ID 83702-4501
Phone 208-422-1000 · Fax 208-422-1080
Mailing address
2827 Heather PlBoise, ID 83702-1428
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