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General NPI Number Information
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NPI Number | 1215910641
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Entity Type | Individual
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Provider Name | NANCY COZETTE EKELUND OD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 7355 BLACK BUTTE RD # 2A
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City | SHINGLETOWN
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State | CA
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Zip | 96088-9478
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Country | US
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Telephone | 530-387-5499
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Fax | 530-212-3724
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Provider Business Mailing Address
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Address Line | 7355 BLACK BUTTE RD # 2A
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City | SHINGLETOWN
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State | CA
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Zip | 96088-9478
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Country | US
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Telephone | 530-515-7753
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Fax | 530-212-3724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7944TPG
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License Number State | CA
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