Provider Demographics
NPI:1245223999
Name:KILZER, THOMAS M (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:KILZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1835
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-1835
Mailing Address - Country:US
Mailing Address - Phone:701-258-6100
Mailing Address - Fax:701-258-9882
Practice Address - Street 1:1929 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-258-6100
Practice Address - Fax:701-258-9882
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60138Medicaid
T66892Medicare UPIN
ND60138Medicaid
8831Medicare ID - Type Unspecified