Provider Demographics
NPI:1528175429
Name:3-D OPTICAL INC
Entity type:Organization
Organization Name:3-D OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CRISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-234-0939
Mailing Address - Street 1:3402 13TH AVE S
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6324
Mailing Address - Country:US
Mailing Address - Phone:701-234-0939
Mailing Address - Fax:701-234-9442
Practice Address - Street 1:3402 13TH AVE S
Practice Address - Street 2:SUITE E
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6324
Practice Address - Country:US
Practice Address - Phone:701-234-0939
Practice Address - Fax:701-234-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3980480001Medicare NSC
NDN70772Medicare PIN