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General NPI Number Information
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NPI Number | 1396907010
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Entity Type | Organization
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Legal Business Name | DR. THOMAS M. KILZER - OPTOMETERIST - PC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 1929 N WASHINGTON ST
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City | BISMARCK
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State | ND
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Zip | 58501-1616
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Country | US
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Telephone | 701-258-6100
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Fax | 701-258-9882
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Provider Business Mailing Address
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Address Line | 1929 N WASHINGTON ST
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City | BISMARCK
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State | ND
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Zip | 58501-1616
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Country | US
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Telephone | 701-258-6100
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Fax | 701-258-9882
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS M KILZER
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Credential | O.D.
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Telephone | 701-258-6100
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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 | 332
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License Number State | ND
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