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NPI Code Detail

MEDICARE: CAPITOL EYECARE PC

MEDICARE: CAPITOL EYECARE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1144013236
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAPITOL EYECARE PC
Provider Business Mailing Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-471-0465
Fax Number : 701-712-5662
Provider Business Practice Location Address
First Line : 1325 57TH AVE NE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6581
Country : US
Telephone Number : 701-471-0465
Fax Number : 701-712-5662
Authorized Official
Title or Position : PRESIDENT
Name : NICHOL DILLAVOU
Credential : OD
Telephone Number : 701-471-0465
Provider Enumeration Date : 05/22/2025
Last Update Date : 05/22/2025

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Directions to “CAPITOL EYECARE PC ” Practice Location

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