MEDICARE: NORTH DAKOTA EYE CLINIC, LTD

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
1	261QM2500X	Medical Specialty Clinic/Center	8411	ND
2	174400000X	Specialist	8411	ND

General Provider Information

NPI Number	:	1972563815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DAKOTA EYE CLINIC, LTD

Provider Business Mailing Address
First Line	:	1820 S 42ND ST.
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4018
Country	:	US
Telephone Number	:	701-775-3151
Fax Number	:	701-775-3153

Provider Business Practice Location Address
First Line	:	1820 S 42ND ST.
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5820
Country	:	US
Telephone Number	:	17-775-3151
Fax Number	:	701-775-3153

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MARK L. SCZEPANSKI
Credential	:	MD
Telephone Number	:	701-775-3151

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/11/2023

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