Provider Demographics
NPI:1215910641
Name:EKELUND, NANCY COZETTE (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:COZETTE
Last Name:EKELUND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 BLACK BUTTE RD # 2A
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9478
Mailing Address - Country:US
Mailing Address - Phone:530-515-7753
Mailing Address - Fax:530-212-3724
Practice Address - Street 1:7355 BLACK BUTTE RD # 2A
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088-9478
Practice Address - Country:US
Practice Address - Phone:530-387-5499
Practice Address - Fax:530-212-3724
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7944TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079440Medicaid
CAP00053363Medicare PIN
U09122Medicare UPIN
CASD0079441Medicare ID - Type Unspecified
CA5198620001Medicare NSC