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General NPI Number Information
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NPI Number | 1730173238
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Entity Type | Organization
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Legal Business Name | CAVALIER OPTOMETRY CLINIC LTD
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 201 E 3RD AVE S
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City | CAVALIER
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State | ND
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Zip | 58220
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Country | US
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Telephone | 701-265-8315
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Fax | 701-265-8317
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | CAVALIER
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State | ND
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Zip | 58220-0148
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Country | US
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Telephone | 701-265-8315
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Fax | 701-265-8317
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. S MEREDITH CLARK
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Credential | O.D.
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Telephone | 701-265-8315
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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 | 358
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License Number State | ND
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