Provider Demographics
NPI:1154590727
Name:JAMES A. WOODMANSEE. OD, PC
Entity type:Organization
Organization Name:JAMES A. WOODMANSEE. OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODMANSEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-780-8726
Mailing Address - Street 1:2551 32ND AVE S
Mailing Address - Street 2:JAMES A. WOODMANSEE OD PC
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3607
Mailing Address - Country:US
Mailing Address - Phone:701-780-8726
Mailing Address - Fax:701-780-1284
Practice Address - Street 1:2551 32ND AVE S
Practice Address - Street 2:JAMES A. WOODMANSEE OD PC
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3607
Practice Address - Country:US
Practice Address - Phone:701-780-8726
Practice Address - Fax:701-780-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60499Medicaid
ND25729Medicare PIN
NDN711352Medicare PIN