Provider Demographics
NPI:1003085523
Name:DYE, JOHN GREGORY (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:DYE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1207 PRAIRIE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3145
Mailing Address - Country:US
Mailing Address - Phone:701-282-2020
Mailing Address - Fax:701-282-0230
Practice Address - Street 1:1207 PRAIRIE PKWY
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3145
Practice Address - Country:US
Practice Address - Phone:701-282-2020
Practice Address - Fax:701-282-0230
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND 378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60533Medicaid
ND20608Medicare PIN
NDP66866Medicare UPIN