Active NPI
Douglas Jack Ekholm, OD DOCTOR OF OPTOMET
- Optometrist
- Lansing, MI
National Provider Identifier
1104983808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002272
- Practice address
- 5417 W Saginaw Hwy
Care of Wallace Opticians
Lansing, MI 48917 - Phone
- (517) 323-4027
- Fax
- (517) 323-1807
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002272 | MI | Primary |
Addresses
Primary practice location
5417 W Saginaw Hwy
Care of Wallace Opticians
Lansing, MI 48917
Mailing address
5417 W Saginaw Hwy
Care of Wallace Opticians
Lansing, MI 48917
Phone (517) 323-4027
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002272 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104983808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5417 W SAGINAW HWY",
"address_2": "CARE OF WALLACE OPTICIANS",
"city": "LANSING",
"state": "MI",
"postal_code": "48917",
"telephone_number": "517-323-4027",
"fax_number": "517-323-1807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5417 W SAGINAW HWY",
"address_2": "CARE OF WALLACE OPTICIANS",
"city": "LANSING",
"state": "MI",
"postal_code": "48917",
"telephone_number": "517-323-4027",
"fax_number": "517-323-1807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EKHOLM",
"first_name": "DOUGLAS",
"middle_name": "JACK",
"name_prefix": "Dr.",
"credential": "OD DOCTOR OF OPTOMET",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.