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General NPI Number Information
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NPI Number | 1851341267
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Entity Type | Individual
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Provider Name | JAMES ALAN EICKELMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 3954 SANDALWOOD LN
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City | PUEBLO
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State | CO
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Zip | 81005-2586
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Country | US
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Telephone | 719-561-2244
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Fax | 719-561-9329
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Provider Business Mailing Address
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Address Line | 27 MONTEBELLO RD
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City | PUEBLO
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State | CO
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Zip | 81001-1236
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Country | US
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Telephone | 719-545-1530
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Fax | 719-545-2899
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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 | 1163
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 497
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License Number State | NM
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