Healthcare Provider Details

I. General information

NPI: 1831872969
Provider Name (Legal Business Name): BISMARCK LASIK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N 9TH ST
BISMARCK ND
58501-4112
US

IV. Provider business mailing address

620 N 9TH ST
BISMARCK ND
58501-4112
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-2020
  • Fax: 701-255-4934
Mailing address:
  • Phone: 701-222-2020
  • Fax: 701-255-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY JACOBCHICK
Title or Position: CENTER MANAGER
Credential: COA
Phone: 701-222-2020