Ellenbecker, Wayne D
Ellenbecker, Wayne D is an individual health care provider with primary practice located at 1250 W Ironwood Dr Suite 201, Coeur D Alene ID 83814-2679. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ellenbecker, Wayne D can be contacted via phone (208) 667-2255.Contact Information
Primary practice address
1250 W Ironwood Dr Suite 201
Coeur D Alene ID 83814-2679
Phone: (208) 667-2255
Fax: (208) 765-5889
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 800 | Idaho |
Profile Details
| NPI number | 1710972450 |
|---|---|
| LBN Legal business name | Ellenbecker, Wayne D |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 19th, 2005 |
| Last updated | Sep 25th, 2017 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710972450 | NPPES |
| Idaho | MEDICAID | 002689900 |
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