Provider Demographics
NPI:1932279551
Name:EKLOF, PAUL G (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
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 1060
Mailing Address - Street 2:115 OLSEN BLVD
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321
Mailing Address - Country:US
Mailing Address - Phone:320-286-5695
Mailing Address - Fax:320-286-5742
Practice Address - Street 1:115 OLSEN BLVD
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321
Practice Address - Country:US
Practice Address - Phone:320-286-5695
Practice Address - Fax:320-286-5742
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN432724100Medicaid
T65482Medicare UPIN
410000865Medicare ID - Type Unspecified