Provider Demographics
NPI:1972563815
Name:NORTH DAKOTA EYE CLINIC, LTD
Entity type:Organization
Organization Name:NORTH DAKOTA EYE CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCZEPANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-775-3151
Mailing Address - Street 1:1820 S 42ND ST.
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4018
Mailing Address - Country:US
Mailing Address - Phone:701-775-3151
Mailing Address - Fax:701-775-3153
Practice Address - Street 1:1820 S 42ND ST.
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5820
Practice Address - Country:US
Practice Address - Phone:017-775-3151
Practice Address - Fax:701-775-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8411174400000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDE25355Medicare UPIN
NDD26009Medicare UPIN
NDT66865Medicare UPIN
ND0352000001Medicare NSC
NDU57795Medicare UPIN
NDH13110Medicare UPIN