Provider Demographics
NPI:1679631477
Name:EYES ON PARKWAY PC
Entity Type:Organization
Organization Name:EYES ON PARKWAY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-258-4384
Mailing Address - Street 1:2331 TYLER PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0871
Mailing Address - Country:US
Mailing Address - Phone:701-258-4384
Mailing Address - Fax:701-258-4394
Practice Address - Street 1:2331 TYLER PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0871
Practice Address - Country:US
Practice Address - Phone:701-258-4384
Practice Address - Fax:701-258-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
712503Medicare PIN
ND5926120001Medicare NSC