| Eye Center Of The Dakotas | |
|
1221 W Divide Ave Ste 1 Bismarck ND 58501-1224 | |
| (701) 224-0661 | |
| (701) 224-0663 |
| Full Name | Eye Center Of The Dakotas |
|---|---|
| Speciality | Clinic/Center |
| Location | 1221 W Divide Ave, Bismarck, North Dakota |
| Authorized Official Name and Position | Robert D. Nordstrom (OWNER) |
| Authorized Official Contact | 7012240661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eye Center Of The Dakotas 1221 W Divide Ave Ste 1 Bismarck ND 58501-1224 Ph: (701) 224-0661 | Eye Center Of The Dakotas 1221 W Divide Ave Ste 1 Bismarck ND 58501-1224 Ph: (701) 224-0661 |
| NPI Number | 1548360761 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 07/08/2008 |
| Medicare PECOS PAC ID | 7911965041 |
|---|---|
| Medicare Enrollment ID | O20041227000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548360761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Timothy L Tello |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1346348000 PECOS PAC ID: 0042117616 Enrollment ID: I20031212000879 |
| Provider Name | Danelle F Moch |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1255323796 PECOS PAC ID: 7315905437 Enrollment ID: I20041221000649 |
| Provider Name | Kari J Burgard |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164713392 PECOS PAC ID: 1254588387 Enrollment ID: I20120824000622 |
| Provider Name | Kellen E Pathroff |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1588004592 PECOS PAC ID: 2860636784 Enrollment ID: I20130916000464 |
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