Dr. Ellen Lille Ellsworth, O.D.
Optometrist in Mentor, OH. Individual provider (NPI-1).
NPI number1437297264
StatusActive
Last updated in NPPESJul 2, 2008
Details
- NPI
- 1437297264
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ellen Lille Ellsworth
- Credential
- O.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 2, 2007
- Last updated
- Jul 2, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 4277 T228 | OH | Yes |
Practice location
9930 Johnnycake Ridge RdSuite 4b
Mentor, OH 44060-6752
Phone 440-352-8031 · Fax 440-352-7671
Mailing address
9930 Johnnycake Ridge RdSuite 4b
Mentor, OH 44060-6752
Phone 440-352-8031 · Fax 440-352-7671
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