1215151527 NPI number — MOSER EYES, INC

Table of content: YOLHELMINE EARLY SUNSHINE CESAR (NPI 1346105491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215151527 NPI number — MOSER EYES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSER EYES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215151527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 S COLUMBIA RD
Provider Second Line Business Mailing Address:
COLUMBIA MALL, BOX 29
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201-6076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-746-4240
Provider Business Mailing Address Fax Number:
701-775-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 S COLUMBIA RD
Provider Second Line Business Practice Location Address:
COLUMBIA MALL, BOX 29
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-746-4240
Provider Business Practice Location Address Fax Number:
701-775-5112
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSER
Authorized Official First Name:
WADE
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
701-746-4240

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  141143 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8B934ST . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 022965 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 18351 . This is a "SPECTERA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: MOS 892718 . This is a "VISION SERVICES INC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: ND 1143 . This is a "EYEMED" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 24377 . This is a "AVESIS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com