Organization
LUMEN VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN THOMAS CAPOUCH OD (FOUNDER/CEO)
(701) 404-9096
Entity
Organization
Contact information
Practice address
5120 PROSPERITY WAY S STE 114, FARGO, ND 58104-7568
(701) 404-9096
Mailing address
6844 17TH ST S, FARGO, ND 58104-7857
(701) 404-9096
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/09/2020
Last updated
06/02/2021
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