Provider Demographics
NPI:1194767129
Name:SPRINGAN, JOEL H (OD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:H
Last Name:SPRINGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6515
Mailing Address - Country:US
Mailing Address - Phone:701-355-4446
Mailing Address - Fax:
Practice Address - Street 1:3119 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0664
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-255-3493
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-03333OtherMEDICA - NORTH CLINIC
MT482596Medicaid
ND24734OtherBCBS - NORTH CLINIC
870435OtherNDVSI - MAIN CLINIC
22-03334OtherMEDICA - MAIN CLINIC
22986OtherSIOUX VALLEY HEALTH PLAN
488241044248OtherPREFERRED ONE
ND60321Medicaid
892876OtherNDVSI - NORTH CLINIC
SD9203090Medicaid
ND0435OtherEYEMED
410038213OtherRAILROAD MEDICARE ID
ND17383OtherBCBS - MAIN CLINIC
61503OtherCOAST TO COAST
ND200OtherVISION BENEFIT OF AMERICA
ND24734OtherBCBS - NORTH CLINIC
SD9203090Medicaid