Healthcare Provider Details

I. General information

NPI: 1508865700
Provider Name (Legal Business Name): MELANIE OLTMANNS OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2273 3RD AVE W
DICKINSON ND
58601-2605
US

IV. Provider business mailing address

2273 3RD AVE W
DICKINSON ND
58601-2605
US

V. Phone/Fax

Practice location:
  • Phone: 701-225-7886
  • Fax: 701-225-8148
Mailing address:
  • Phone: 701-225-7886
  • Fax: 701-225-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number560
License Number StateND

VIII. Authorized Official

Name: DR. NATHANIEL DEAN SHILMAN
Title or Position: OWNER
Credential: OD
Phone: 701-225-7886