Provider Demographics
NPI:1326276171
Name:MODERN EYES LLC
Entity Type:Organization
Organization Name:MODERN EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-426-7403
Mailing Address - Street 1:121 N 3RD ST.
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-223-2775
Mailing Address - Fax:701-751-0914
Practice Address - Street 1:121 N 3RD ST.
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-223-2775
Practice Address - Fax:701-751-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND892997OtherVSI