MEDICARE: DR. LARRY L EKLUND O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	273T	WY
2	152WC0802X	Corneal and Contact Management Optometrist	2211	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80549-A001	OTHER	CO	TRICARE

General Provider Information

NPI Number	:	1831151414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY L EKLUND O.D.

Provider Business Mailing Address
First Line	:	PO BOX 350
Second Line	:
City	:	WELLINGTON
State	:	CO
Zip	:	80549-0350
Country	:	US
Telephone Number	:	970-568-7161
Fax Number	:	970-568-7074

Provider Business Practice Location Address
First Line	:	8251 WELLINGTON BLVD
Second Line	:	UNIT 1
City	:	WELLINGTON
State	:	CO
Zip	:	80549-3255
Country	:	US
Telephone Number	:	970-568-7161
Fax Number	:	970-568-7074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/28/2022

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