Provider Demographics
NPI:1306822861
Name:EKLOF, RICHARD H (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:EKLOF
Suffix:
Gender:M
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-0108
Mailing Address - Country:US
Mailing Address - Phone:701-256-2269
Mailing Address - Fax:701-256-2268
Practice Address - Street 1:324 9TH AVE
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2433
Practice Address - Country:US
Practice Address - Phone:701-256-2269
Practice Address - Fax:701-256-2268
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60238Medicaid
N8813Medicare PIN
T66867Medicare UPIN
ND0657610001Medicare NSC