Provider Demographics
NPI:1447872304
Name:ELLIS, PAIGE (OD)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6690 GLENALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4032
Mailing Address - Country:US
Mailing Address - Phone:812-746-9914
Mailing Address - Fax:
Practice Address - Street 1:159 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3128
Practice Address - Country:US
Practice Address - Phone:330-297-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist