Provider Demographics
NPI:1508865700
Name:MELANIE OLTMANNS OD PC
Entity Type:Organization
Organization Name:MELANIE OLTMANNS OD PC
Other - Org Name:EYEWEAR CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-225-7886
Mailing Address - Street 1:2273 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2605
Mailing Address - Country:US
Mailing Address - Phone:701-225-7886
Mailing Address - Fax:701-225-8148
Practice Address - Street 1:2273 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2605
Practice Address - Country:US
Practice Address - Phone:701-225-7886
Practice Address - Fax:701-225-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60607Medicaid
ND60607Medicaid
U66512Medicare UPIN