Provider Demographics
NPI:1447091038
Name:DAMON MATTHEW ELLIS
Entity type:Organization
Organization Name:DAMON MATTHEW ELLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-948-6310
Mailing Address - Street 1:1306 W AVENUE J STE B
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2936
Mailing Address - Country:US
Mailing Address - Phone:661-948-6310
Mailing Address - Fax:
Practice Address - Street 1:1306 W AVENUE J STE B
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2936
Practice Address - Country:US
Practice Address - Phone:661-948-6310
Practice Address - Fax:661-948-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty