Ellenbecker Eye Clinic, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

800 Issued in ID

Legal business name

ELLENBECKER EYE CLINIC, PLLC

Practice address

1250 W Ironwood Dr
Suite 201
Coeur D Alene, ID 83814-2681

Phone

(208) 667-2255

Fax

(208) 765-5889

NPI assigned

Sep 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wayne D Ellenbecker, ODNPI 1710972450

Title

Optometrist/Owner

Phone

(208) 667-2255

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wayne D Ellenbecker, O.D.

  • Optometrist
  • Coeur D Alene, ID
  • NPI 1710972450
  Medicare reassignment Care Compare group NPD Authorized official
• Cindy L Ellenbecker, OD

  • Optometrist
  • Coeur D Alene, ID
  • NPI 1134167703
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220572800000",
    "number": "1205931995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 W IRONWOOD DR",
            "address_2": "SUITE 201",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142681",
            "telephone_number": "208-667-2255",
            "fax_number": "208-765-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 W IRONWOOD DR",
            "address_2": "SUITE 201",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142681",
            "telephone_number": "208-667-2255",
            "fax_number": "208-765-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLENBECKER EYE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-09-05",
        "status": "A",
        "authorized_official_last_name": "ELLENBECKER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "208-667-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Eldridge
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• Cindy L Ellenbecker, OD
• Wayne D Ellenbecker, O.D.
• Brenda G Elliff, RN
• Shawna Elliott
• Yvonne L Elliott, P.T.

• Optometrist in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.