Provider Demographics
NPI:1265539639
Name:DRS MOEN ENDERLE AND KREIN PC
Entity type:Organization
Organization Name:DRS MOEN ENDERLE AND KREIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-662-4085
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0130
Mailing Address - Country:US
Mailing Address - Phone:701-662-4085
Mailing Address - Fax:701-662-6685
Practice Address - Street 1:404 HWY 2 EAST
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-0130
Practice Address - Country:US
Practice Address - Phone:701-662-4085
Practice Address - Fax:701-662-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60573Medicaid
NDCI2649OtherPALMETTO GBA RAILROAD MEDICARE
NDCI2649OtherPALMETTO GBA RAILROAD MEDICARE