Healthcare Provider Details

I. General information

NPI: 1205812393
Provider Name (Legal Business Name): EYES BY DESIGN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 SOUTH MAIN ST
WATFORD CITY ND
58854
US

IV. Provider business mailing address

1005 SOUTH MAIN ST
WATFORD CITY ND
58854
US

V. Phone/Fax

Practice location:
  • Phone: 701-444-3221
  • Fax: 701-444-2448
Mailing address:
  • Phone: 701-444-3221
  • Fax: 701-444-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number443
License Number StateND

VIII. Authorized Official

Name: MELISSA PHYLLIS HJELDEN
Title or Position: PRESIDENT
Credential:
Phone: 701-444-3221