Provider Demographics
NPI:1871031153
Name:WEST FARGO EYECARE ASSOCIATES PC
Entity Type:Organization
Organization Name:WEST FARGO EYECARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-282-5880
Mailing Address - Street 1:3139 BLUESTEM DR
Mailing Address - Street 2:STE 112
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8089
Mailing Address - Country:US
Mailing Address - Phone:701-353-7136
Mailing Address - Fax:701-532-0321
Practice Address - Street 1:3139 BLUESTEM DR
Practice Address - Street 2:STE 112
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8089
Practice Address - Country:US
Practice Address - Phone:701-353-7136
Practice Address - Fax:701-532-0321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty