Organization
ELLENBECKER EYE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE D ELLENBECKER OD (OPTOMETRIST/OWNER)
(208) 667-2255
Entity
Organization
Contact information
Practice address
1250 W IRONWOOD DR, SUITE 201, COEUR D ALENE, ID 83814-2681
(208) 667-2255
(208) 765-5889
Mailing address
1250 W IRONWOOD DR, SUITE 201, COEUR D ALENE, ID 83814-2681
(208) 667-2255
(208) 765-5889
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
800
ID
Other
Enumeration date
09/14/2006
Last updated
09/05/2008
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