| |
1211 Lake Ave Ste 102, Berthoud, CO 80513-9381 | |
(970) 532-5605 | |
(970) 532-5607 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 1211 Lake Ave Ste 102, Berthoud, Colorado |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1568589505 | NPI | - | NPPES |
63821371 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT-1026 (Colorado) | Primary |
Provider Name | William R Eland |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1811088495 PECOS PAC ID: 9133109044 Enrollment ID: I20040721001682 |
Provider Name | Corey D Pratt |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1598940777 PECOS PAC ID: 9032498894 Enrollment ID: I20161118000079 |
Mailing Address | Practice Location Address |
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1211 Lake Ave Ste 102, Berthoud, CO 80513-9381 Ph: (970) 532-5605 | 1211 Lake Ave Ste 102, Berthoud, CO 80513-9381 Ph: (970) 532-5605 |
Dr. William Rex Eland, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1211 Lake Ave Ste 102, Berthoud, CO 80513 Phone: 970-532-5605 Fax: 970-532-5607 |