Provider Demographics
NPI:1952371130
Name:BRANDT OPTICARE INC
Entity Type:Organization
Organization Name:BRANDT OPTICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-233-2650
Mailing Address - Street 1:725 CENTER AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1961
Mailing Address - Country:US
Mailing Address - Phone:218-233-2650
Mailing Address - Fax:218-233-2928
Practice Address - Street 1:725 CENTER AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1961
Practice Address - Country:US
Practice Address - Phone:218-233-2650
Practice Address - Fax:218-233-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND8911OtherBCBS ND
MN967523000Medicaid
T65344Medicare UPIN
MN1110860002Medicare NSC
ND8911OtherBCBS ND
MNC07259Medicare PIN