Organization
NORTHEAST EYE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A DICKEN MD (PRESIDENT)
(701) 662-4085
Entity
Organization
Contact information
Practice address
404 HWY 2 E, DEVILS LAKE, ND 58301-0130
(701) 662-4085
(701) 662-6010
Mailing address
PO BOX 130, DEVILS LAKE, ND 58301-0130
(701) 662-4085
(701) 662-6010
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05557001
BLUE CROSS BLUE SHIELD ND
—
05
—
17954
—
ND
01
—
2F903DO
BLUE SHIELD MN
—
01
—
CJ5092
MEDICARE RETIRED RAILROAD
—
Enumeration date
09/29/2006
Last updated
06/16/2008
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