Provider Demographics
NPI:1518026046
Name:HEARTLAND EYE CARE, P.C.
Entity Type:Organization
Organization Name:HEARTLAND EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-284-7330
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-0370
Mailing Address - Country:US
Mailing Address - Phone:701-352-1370
Mailing Address - Fax:701-352-1376
Practice Address - Street 1:415 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1001
Practice Address - Country:US
Practice Address - Phone:701-352-1370
Practice Address - Fax:701-352-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00485001OtherBLUE CROSS BLUE SHIELD
NDCO4132OtherPALMETTO GBA-RAILROAD MC
ND60418Medicaid
ND0280490002Medicare NSC
NDN70358Medicare PIN