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General NPI Number Information
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NPI Number | 1932277936
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Entity Type | Organization
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Legal Business Name | HEARTLAND EYE CARE, PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 BRIGGS AVE N
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City | PARK RIVER
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State | ND
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Zip | 58270-0714
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Country | US
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Telephone | 701-284-7330
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Fax | 701-284-7332
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Provider Business Mailing Address
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Address Line | PO BOX O
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City | PARK RIVER
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State | ND
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Zip | 58270-0714
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Country | US
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Telephone | 701-284-7330
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Fax | 701-284-7332
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | DORI M CARLSON
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Credential | OD
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Telephone | 701-284-7330
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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 |
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License Number State |
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