Provider Demographics
NPI:1881687010
Name:BEULAH VISION PC
Entity Type:Organization
Organization Name:BEULAH VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMERSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-873-5251
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-0699
Mailing Address - Country:US
Mailing Address - Phone:701-873-5251
Mailing Address - Fax:701-873-2141
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523
Practice Address - Country:US
Practice Address - Phone:701-873-5251
Practice Address - Fax:701-873-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND0003002OtherHUMANA
ND2203717OtherSECURE HORIZONS DIRECT
ND595020OtherADVANTRA FREEDOM
ND8823OtherBCBS
ND410029162OtherRAILROAD MEDICARE
ND870403OtherNORTH DAKOTA VISION SERVICES
ND60574Medicaid
NDND0003002OtherHUMANA
ND0648790001Medicare NSC
ND2203717OtherSECURE HORIZONS DIRECT
NDND0003002OtherHUMANA
ND870403OtherNORTH DAKOTA VISION SERVICES