Provider Demographics
NPI:1831151414
Name:EKLUND, LARRY L (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:EKLUND
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 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
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY273T152WC0802X
CO2211152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89350341Medicaid
CO80549-A001OtherTRICARE
CO89350341Medicaid
CO80549-A001OtherTRICARE
COU86553Medicare UPIN