Provider Demographics
NPI:1932160132
Name:HELGESON, MARK K (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:HELGESON
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:PO BOX O
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-0714
Mailing Address - Country:US
Mailing Address - Phone:701-284-7330
Mailing Address - Fax:701-284-7332
Practice Address - Street 1:121 BRIGGS AVE N
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-0714
Practice Address - Country:US
Practice Address - Phone:701-284-7330
Practice Address - Fax:701-284-7332
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932160132OtherNPI
ND60451Medicaid
ND60451Medicaid