Provider Demographics
NPI:1851341267
Name:EICKELMAN, JAMES ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:EICKELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 MONTEBELLO RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:3954 SANDALWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2586
Practice Address - Country:US
Practice Address - Phone:719-561-2244
Practice Address - Fax:719-561-9329
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1163152W00000X
NM497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28378261Medicaid
NMNM00PA58OtherNM BCBS
NM0452890003OtherMEDICARE DMERC
CO410046891OtherRAILROAD MEDICARE
CO08116394Medicaid
COCO1163OtherEYEMED EYECARE
CO608439600OtherUS DEP LAB WORK COMP
CO920725020820OtherEYE SPECIALIST
COEIE0596OtherANTHEM BCBS
COEIE0596OtherFEDERAL BCBS
NMNM00PA58OtherNM BCBS
COEIE0596OtherFEDERAL BCBS
COCO1163OtherEYEMED EYECARE