Provider Demographics
NPI:1760660658
Name:MARK A EMMERICH
Entity Type:Organization
Organization Name:MARK A EMMERICH
Other - Org Name:EMMERICH EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:EMMERICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-225-9601
Mailing Address - Street 1:34 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5209
Mailing Address - Country:US
Mailing Address - Phone:701-225-9601
Mailing Address - Fax:701-483-9601
Practice Address - Street 1:34 1ST ST E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5209
Practice Address - Country:US
Practice Address - Phone:701-225-9601
Practice Address - Fax:701-483-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty