Provider Demographics
NPI:1912008335
Name:WOODMANSEE, JAMES A (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WOODMANSEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3750 32ND AVE S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5998
Mailing Address - Country:US
Mailing Address - Phone:701-780-8726
Mailing Address - Fax:701-780-1284
Practice Address - Street 1:3750 32ND AVE S
Practice Address - Street 2:SUITE 109
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5998
Practice Address - Country:US
Practice Address - Phone:701-780-8726
Practice Address - Fax:701-780-1284
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13459OtherSPECTERA
48409OtherDAVIS VISION
ND800557OtherND VISION SERVICES
A001OtherTRICARE
ND60499Medicaid
14196OtherNORIDIAN MUTUAL
551545OtherNVA
POO219448/DD2923OtherRRMDCR
ND800557OtherND VISION SERVICES
ND60499Medicaid
A001OtherTRICARE