Provider Demographics
NPI:1871789065
Name:EKLUND OPTOMETRIC GROUP
Entity type:Organization
Organization Name:EKLUND OPTOMETRIC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-568-7161
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0350
Mailing Address - Country:US
Mailing Address - Phone:970-568-7161
Mailing Address - Fax:970-568-7074
Practice Address - Street 1:8251 WELLINGTON BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-3255
Practice Address - Country:US
Practice Address - Phone:970-568-7161
Practice Address - Fax:970-568-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2211152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89350341Medicaid
CO89350341Medicaid
COC527998Medicare PIN