Provider Demographics
NPI:1396907010
Name:DR. THOMAS M. KILZER - OPTOMETERIST - PC
Entity type:Organization
Organization Name:DR. THOMAS M. KILZER - OPTOMETERIST - PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KILZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-258-6100
Mailing Address - Street 1:1929 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-258-6100
Mailing Address - Fax:701-258-9882
Practice Address - Street 1:1929 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-258-6100
Practice Address - Fax:701-258-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND332332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60138Medicaid
NDT66892Medicare UPIN
ND0205000001Medicare NSC
ND8831Medicare PIN