Individual
DR. JAMES ALAN EICKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3954 SANDALWOOD LN, PUEBLO, CO 81005-2586
(719) 561-2244
(719) 561-9329
Mailing address
27 MONTEBELLO RD, PUEBLO, CO 81001-1236
(719) 545-1530
(719) 545-2899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1163
CO
152W00000X
Optometrist
497
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0452890003
MEDICARE DMERC
NM
05
—
08116394
—
CO
05
—
28378261
—
NM
01
—
410046891
RAILROAD MEDICARE
CO
01
—
608439600
US DEP LAB WORK COMP
CO
01
—
920725020820
EYE SPECIALIST
CO
01
—
CO1163
EYEMED EYECARE
CO
01
—
EIE0596
ANTHEM BCBS
CO
01
—
NM00PA58
NM BCBS
NM
Enumeration date
05/10/2006
Last updated
12/05/2012
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