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General NPI Number Information
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NPI Number | 1679849236
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Entity Type | Organization
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Legal Business Name | DRAYTON EYE CLINIC
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 104 E HIGHWAY 66 STE 102
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City | DRAYTON
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State | ND
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Zip | 58225-4804
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Country | US
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Telephone | 701-454-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E HIGHWAY 66 STE 102
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City | DRAYTON
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State | ND
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Zip | 58225-4804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | THOMAS DUNHAM
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Credential | OD
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Telephone | 701-454-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 421
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License Number State | ND
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