Provider Demographics
NPI:1962823450
Name:RICHARD H EKLOF OD PC
Entity Type:Organization
Organization Name:RICHARD H EKLOF OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:EKLOF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-256-2269
Mailing Address - Street 1:324 9TH AVE
Mailing Address - Street 2:P.O. BOX 108
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60238Medicaid
0657610001Medicare NSC
ND60238Medicaid
N8813Medicare PIN