Provider Demographics
NPI:1043308372
Name:RODENBIKER, HAROLD T (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:T
Last Name:RODENBIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 4TH ST S STE 612
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1940
Mailing Address - Country:US
Mailing Address - Phone:701-235-0561
Mailing Address - Fax:701-235-0330
Practice Address - Street 1:100 4TH ST S STE 612
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1940
Practice Address - Country:US
Practice Address - Phone:701-235-0561
Practice Address - Fax:701-235-0330
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5102207W00000X
MN29919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2M040ROOtherBLUE SHIELD
ND14692Medicaid
ND11358OtherBLUE SHIELD
ND892810OtherVISION SERVICES
NDD26245Medicare UPIN
ND892810OtherVISION SERVICES