Provider Demographics
NPI:1104950989
Name:BLAIR AND ELLIS P.A.
Entity type:Organization
Organization Name:BLAIR AND ELLIS P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:915-533-1811
Mailing Address - Street 1:3800 N MESA ST STE B1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1535
Mailing Address - Country:US
Mailing Address - Phone:915-533-1811
Mailing Address - Fax:915-533-3641
Practice Address - Street 1:3800 N MESA ST STE B1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1535
Practice Address - Country:US
Practice Address - Phone:915-533-1811
Practice Address - Fax:915-533-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160388801Medicaid
TX180559001Medicaid
TX35FCOtherBLUE CROSS BLUE SHIELD
NM96256028Medicaid