Individual
MICHAEL A CANDREVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
10 N RIVER ROAD, FORT YATES, ND 58538
(701) 854-8248
(701) 854-7411
Mailing address
N 10 RIVER ROAD, FORT YATES, ND 58538
(701) 854-8248
(701) 854-7411
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CO1796
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5540010
—
ND
Enumeration date
02/03/2007
Last updated
08/17/2018
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