Individual
DR. MARK A MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
404 HWY 2 EAST, DEVILS LAKE, ND 58301-0130
(701) 662-4085
(701) 662-6685
Mailing address
PO BOX 130, DEVILS LAKE, ND 58301-0130
(701) 662-4085
(701) 662-6685
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
441
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0311120001
CIGNA MEDICARE SERVICE
ND
01
—
450433379000
WORKERS SAFETY AND COMP
ND
05
—
60342
—
ND
01
—
800441
ND VISION SERVICES
ND
01
—
8844
BS OF NORTH DAKOTA
ND
01
—
CI2649
PALMETTO GBA - RAILROAD MEDICARE
ND
Enumeration date
09/15/2006
Last updated
05/15/2008
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