Provider Demographics
NPI:1962449835
Name:DAKOTA EYE INSTITUTE PC
Entity Type:Organization
Organization Name:DAKOTA EYE INSTITUTE PC
Other - Org Name:THE EYE SPECIALISTS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-3937
Mailing Address - Street 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5675
Mailing Address - Country:US
Mailing Address - Phone:701-222-3937
Mailing Address - Fax:701-222-8805
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5675
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-222-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1453152Medicaid
892877OtherNDVSI - NORTH CLINIC
ND00278002OtherBCBS - NORTH CLINIC
ND0448OtherEYEMED
ND00933OtherSUBMITTER ID #
CO4124OtherRAILROAD MEDICARE ID
801758OtherNDVSI - MAIN CLINIC
ND00278001OtherBCBS
ND16267Medicaid
24735 & 70805OtherTRIWEST HEALTHCARE
ND00933OtherSUBMITTER ID #
24735 & 70805OtherTRIWEST HEALTHCARE