Provider Demographics
NPI:1588749337
Name:FERCHO CATARACT AND EYE CLINIC
Entity type:Organization
Organization Name:FERCHO CATARACT AND EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-0561
Mailing Address - Street 1:100 4TH ST S STE 612
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1940
Mailing Address - Country:US
Mailing Address - Phone:701-235-0561
Mailing Address - Fax:701-235-0330
Practice Address - Street 1:100 4TH ST S STE 612
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1940
Practice Address - Country:US
Practice Address - Phone:701-235-0561
Practice Address - Fax:701-235-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND02-09560001OtherDMERC