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NPI Code Detail

MEDICARE: NICHOL K DILLAVOU O.D.

MEDICARE: NICHOL K DILLAVOU O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist591ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558470401
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOL K DILLAVOU O.D.
Provider Business Mailing Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-471-0465
Fax Number : 701-712-5662
Provider Business Practice Location Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-471-0465
Fax Number : 701-712-5662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 04/28/2025

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