Provider Demographics
NPI:1376695932
Name:BIESIOT, VINCENT HENRY (OD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:HENRY
Last Name:BIESIOT
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 1:1071 12TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3655
Mailing Address - Country:US
Mailing Address - Phone:701-225-5255
Mailing Address - Fax:
Practice Address - Street 1:2456 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2608
Practice Address - Country:US
Practice Address - Phone:701-456-8035
Practice Address - Fax:701-456-8037
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist