Wayne D Ellenbecker, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

800 Issued in ID

Practice address

1250 W Ironwood Dr
Suite 201
Coeur D Alene, ID 83814-2679

Phone

(208) 667-2255

Fax

(208) 765-5889

NPI assigned

Sep 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ellenbecker Eye Clinic, PLLCGroup PAC ID 4587660782, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ellenbecker Eye Clinic, PLLC

  • Optometrist
  • Coeur d'Alene, ID
  • NPI 1205931995
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1710972450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 W RIVERSTONE DR",
            "address_2": "STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144968",
            "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": "838142679",
            "telephone_number": "208-667-2255",
            "fax_number": "208-765-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBECKER",
        "first_name": "WAYNE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002689900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leanne Elisha, PMHNP
• Elite Eyecare PC (Ironwood Vision Center)
• Elite Sports and Orthopedic Physical Therapy LLC
• Ellenbecker Eye Clinic, PLLC
• Cindy L Ellenbecker, OD
• Brenda G Elliff, RN
• Shawna Elliott
• Yvonne L Elliott, P.T.
• Jill Ellis
• Kathleen Ellis

• 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 Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.