=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962823450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD H EKLOF OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2013
-----------------------------------------------------
Last Update Date | 12/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 9TH AVE
-----------------------------------------------------
City | LANGDON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58249-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-256-2269
-----------------------------------------------------
Fax | 701-256-2268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 9TH AVE P.O. BOX 108
-----------------------------------------------------
City | LANGDON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58249-0108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-256-2269
-----------------------------------------------------
Fax | 701-256-2268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD H EKLOF
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 701-256-2269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 388
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------