Healthcare Provider Details

I. General information

NPI: 1255397329
Provider Name (Legal Business Name): DAVID JOSEPH BELLWARE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 CO HWY 34 WHITE EARTH HEALTH CENTER
OGEMA MN
56569
US

IV. Provider business mailing address

927 PEMBINA
DETROIT LAKES MN
56501
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-4300
  • Fax: 218-983-6217
Mailing address:
  • Phone: 218-375-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4725
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT1529
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1777
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2759
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: