Provider Demographics
NPI:1205093416
Name:DR GEOFFREY RATH OPTOMETRIST PC
Entity type:Organization
Organization Name:DR GEOFFREY RATH OPTOMETRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RATH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-742-3111
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0491
Mailing Address - Country:US
Mailing Address - Phone:701-742-3111
Mailing Address - Fax:701-742-2445
Practice Address - Street 1:409 MAIN AVE
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-1240
Practice Address - Country:US
Practice Address - Phone:701-742-3111
Practice Address - Fax:701-742-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60329Medicaid
NDT66930Medicare UPIN
ND3301Medicare PIN
ND60329Medicaid