Provider Demographics
NPI:1932277936
Name:HEARTLAND EYE CARE, PC
Entity Type:Organization
Organization Name:HEARTLAND EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-284-7330
Mailing Address - Street 1:PO BOX O
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-0714
Mailing Address - Country:US
Mailing Address - Phone:701-284-7330
Mailing Address - Fax:701-284-7332
Practice Address - Street 1:121 BRIGGS AVE N
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-0714
Practice Address - Country:US
Practice Address - Phone:701-284-7330
Practice Address - Fax:701-284-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN84873HEOtherBLUE CROSS BLUE SHIELD
ND339001OtherBLUE CROSS BLUE SHIELD
ND0280490001OtherNAS-CIGNA REGION D
NDCH9068OtherPALMETTO GBA-RAILROAD MC
ND60418Medicaid
ND339001OtherBLUE CROSS BLUE SHIELD