1104915990 NPI number — MR. DAVID CARL SOLSENG OD

Table of content: MR. DAVID CARL SOLSENG OD (NPI 1104915990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104915990 NPI number — MR. DAVID CARL SOLSENG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLSENG
Provider First Name:
DAVID
Provider Middle Name:
CARL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104915990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 S WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-775-3135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-784-4091
Provider Business Practice Location Address Fax Number:
218-784-4092
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  570 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2705 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2200530 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 234001 . This is a "BLUE SHEILD OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 314004100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09G48VA . This is a "BC BS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2200530 . This is a "MEDICA CHOICE SELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09G48VA . This is a "MA-BLUE PLUS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 800570 . This is a "VISION SERVICES INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2200530 . This is a "MEDICA-MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2200530 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60081 . This is a "ND MA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 126057 . This is a "U CARE MINNESOTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 639111042770 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 314004100 . This is a "DEPT OF HUMAN SERVICES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 09G48VA . This is a "BLUE PLUS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com