=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205093416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR GEOFFREY RATH OPTOMETRIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 07/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 MAIN AVE
-----------------------------------------------------
City | OAKES
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58474-1240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-742-3111
-----------------------------------------------------
Fax | 701-742-2445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 491
-----------------------------------------------------
City | OAKES
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58474-0491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-742-3111
-----------------------------------------------------
Fax | 701-742-2445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEOFFREY ALAN RATH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 701-742-3111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 407
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------