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General NPI Number Information
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NPI Number | 1760529408
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Entity Type | Individual
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Provider Name | JAMES A MOLDE O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 506 BELTRAMI AVE NW
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City | BEMIDJI
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State | MN
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Zip | 56601-3010
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Country | US
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Telephone | 218-751-2020
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Fax | 218-759-9228
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Provider Business Mailing Address
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Address Line | 506 BELTRAMI AVE NW
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City | BEMIDJI
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State | MN
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Zip | 56601-3010
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Country | US
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Telephone | 218-751-2020
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Fax | 218-759-9228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1728
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1728
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License Number State | MN
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