Provider Demographics
NPI:1386662427
Name:THORMAN, JOSEPH A (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:THORMAN
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 1:118 THIRD ST NE
Mailing Address - Street 2:PO BOX 1170
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-1170
Mailing Address - Country:US
Mailing Address - Phone:701-477-5656
Mailing Address - Fax:701-477-5675
Practice Address - Street 1:118 THIRD ST NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-1170
Practice Address - Country:US
Practice Address - Phone:701-477-5656
Practice Address - Fax:701-477-5675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60481Medicaid
ND0780610001Medicare NSC