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General NPI Number Information
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NPI Number | 1225323504
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Entity Type | Organization
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Legal Business Name | WILLISTON BASIN EYECARE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 1213 15TH AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-3800
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Country | US
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Telephone | 701-577-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 15TH AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-3800
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Country | US
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Telephone | 701-577-3937
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. LAURALI M SIME
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Credential | OD
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Telephone | 701-577-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 684
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 596
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 438
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 590
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License Number State | ND
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 574
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License Number State | ND
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