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General NPI Number Information
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NPI Number | 1326276171
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Entity Type | Organization
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Legal Business Name | MODERN EYES LLC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 121 N 3RD ST.
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City | BISMARCK
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State | ND
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Zip | 58501
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Country | US
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Telephone | 701-223-2775
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Fax | 701-751-0914
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Provider Business Mailing Address
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Address Line | 121 N 3RD ST.
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City | BISMARCK
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State | ND
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Zip | 58501
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Country | US
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Telephone | 701-223-2775
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Fax | 701-751-0914
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES B. KNUDSEN
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Credential |
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Telephone | 701-426-7403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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