Provider Demographics
NPI:1679654883
Name:SCHLEISMAN, TERRY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAMES
Last Name:SCHLEISMAN
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 1:611 9TH AVENUE NE
Mailing Address - Street 2:BOX 245
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0245
Mailing Address - Country:US
Mailing Address - Phone:701-477-9872
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL WAY
Practice Address - Street 2:BOX 160
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1659ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDU13595Medicare UPIN