Provider Demographics
NPI:1588951636
Name:ELLIS, DANIELLE ERWIN (OD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ERWIN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1210
Mailing Address - Country:US
Mailing Address - Phone:740-622-2270
Mailing Address - Fax:740-622-4376
Practice Address - Street 1:535 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1210
Practice Address - Country:US
Practice Address - Phone:740-622-2270
Practice Address - Fax:740-622-4376
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist