Provider Demographics
NPI:1124200688
Name:VISIONARY EYE CARE
Entity Type:Organization
Organization Name:VISIONARY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-483-9141
Mailing Address - Street 1:341 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5216
Mailing Address - Country:US
Mailing Address - Phone:701-483-9141
Mailing Address - Fax:701-483-9501
Practice Address - Street 1:341 1ST ST E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5216
Practice Address - Country:US
Practice Address - Phone:701-483-9141
Practice Address - Fax:701-483-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND060580Medicaid
ND01284002OtherBCBS
NDDA9711OtherRAILROAD MEDICARE
ND4694550001OtherNORIDIAN
NDDA9711OtherRAILROAD MEDICARE