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ELLENBECKER EYE CLINIC, P.L.L.C.

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Company Details

Name: ELLENBECKER EYE CLINIC, P.L.L.C.
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 06 Dec 1996 (29 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 20339
Place of Formation: IDAHO
File Number: 20339
ZIP code: 83814
County: Kootenai County
Principal Address: 2140 RIVERSTONE DR STE 101 COEUR D'ALENE, ID 83814
Mailing Address: 2020 W RIVERSTONE DR COEUR D ALENE, ID 83814-5698

Member

Name Role Address Appointed On Resigned On
WAYNE D ELLENBECKER OD Member 2020 W RIVERSTONE DR, COEUR D'ALENE, ID 83814 2020-11-08 No data
CINDY L ELLENBECKER Member 2020 W RIVERSTONE DR, COEUR D'ALENE, ID 83814 2023-11-05 2023-11-05
WAYNE D ELLENBECKER Member 2020 W RIVERSTONE DR, COEUR D'ALENE, ID 83814 2021-11-12 No data

Agent

Name Role Address
WAYNE D ELLENBECKER, O.D. Agent 2020 W RIVERSTONE DR, COEUR D'ALENE, ID 83814-5698

National Provider Identifier

NPI Number:
1205931995

Authorized Person:

Name:
DR. WAYNE D ELLENBECKER
Role:
OPTOMETRIST/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
152W00000X - Optometrist
Is Primary:
Yes

Contacts:

Fax:
2087655889

Form 5500 Series

Employer Identification Number (EIN):
820496575
Plan Year:
2023
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
7
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
7
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005959083 2024-11-03
Annual Report 0005463572 2023-11-05
Annual Report 0004990856 2022-11-11
Annual Report 0004496621 2021-11-12
Annual Report 0004062645 2020-11-08

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Date of last update: 25 Aug 2025

Sources: Idaho Secretary of State