Organization
LEIDENIX PC
Active
Other names
Bis-Man Eyecare Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MATTSON (MANAGER)
(701) 663-0012
Entity
Organization
Contact information
Practice address
1400 SKYLINE BLVD, BISMARCK, ND 58503-1613
(701) 255-4117
(701) 255-4174
Mailing address
1000 OLD RED TRL NW, MANDAN, ND 58554-3052
(701) 663-0012
(701) 663-0522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
511
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461913
—
ND
05
—
60631
—
ND
Enumeration date
07/26/2007
Last updated
10/03/2018
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