Provider Demographics
NPI:1649243288
Name:COLBY, DAVID PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:COLBY
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 1:28 2ND ST NW
Mailing Address - Street 2:PO BOX 857
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-7114
Mailing Address - Country:US
Mailing Address - Phone:701-385-4004
Mailing Address - Fax:701-385-4005
Practice Address - Street 1:28 2ND ST NW
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7114
Practice Address - Country:US
Practice Address - Phone:701-385-4004
Practice Address - Fax:701-385-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60306Medicaid
NDT66859Medicare UPIN
ND0175080001Medicare NSC
ND60306Medicaid