Organization
LISBON VISION CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY RAY MAIRS O.D. (PRESIDENT)
(701) 683-5815
Entity
Organization
Contact information
Practice address
17 11TH AVENUE WEST, LISBON, ND 58054-0916
(701) 683-5815
(701) 683-9966
Mailing address
PO BOX 916, LISBON, ND 58054-0916
(701) 683-5815
(701) 683-9966
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
638
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407896673
WCP WORKERS COMP
ND
05
—
60633
—
ND
Enumeration date
06/07/2006
Last updated
10/08/2008
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