Provider Demographics
NPI:1811088495
Name:ELAND, WILLIAM REX (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REX
Last Name:ELAND
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 1:1211 LAKE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-9381
Mailing Address - Country:US
Mailing Address - Phone:970-532-5605
Mailing Address - Fax:970-532-5607
Practice Address - Street 1:1211 LAKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-9381
Practice Address - Country:US
Practice Address - Phone:970-532-5605
Practice Address - Fax:970-532-5607
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-1026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63821371Medicaid
CO0422000001Medicare NSC
COC802170Medicare PIN
COT60790Medicare UPIN
CO410026829Medicare PIN