Provider Demographics
NPI:1487661351
Name:LAMPL, SHILA K (OD)
Entity Type:Individual
Prefix:
First Name:SHILA
Middle Name:K
Last Name:LAMPL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26450OtherNDBS #
ND45425OtherLHS #
ND2202982OtherMEDICA #
NDDA9051044587OtherPREFERRED ONE #
NDHP52854OtherHEALTHPARTNERS #
ND2374577OtherAMERICA'S PPO/ARAZ #
ND60618Medicaid
ND111658400Medicaid
ND008H3LAOtherMNBS #
ND137087OtherUCARE #
ND9203480Medicaid
ND008H3LAOtherMNBS #
ND410002575Medicare ID - Type UnspecifiedMN MEDICARE #
ND26450OtherNDBS #
ND9203480Medicaid