Provider Demographics
NPI:1952537177
Name:NANCY EKELUND EYECARE
Entity Type:Organization
Organization Name:NANCY EKELUND EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EKELUND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-223-4300
Mailing Address - Street 1:2620 LARKSPUR LN
Mailing Address - Street 2:SUITE L
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1044
Mailing Address - Country:US
Mailing Address - Phone:530-223-4300
Mailing Address - Fax:530-222-8903
Practice Address - Street 1:2620 LARKSPUR LN
Practice Address - Street 2:SUITE L
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1044
Practice Address - Country:US
Practice Address - Phone:530-223-4300
Practice Address - Fax:530-222-8903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANCY EKELUND EYECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7944T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5198620001Medicare NSC