Organization
LEIDENIX PC
Active
Other names
Bis-Man Eyecare Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MATTSON (MANAGER)
(701) 663-0012
Entity
Organization
Contact information
Practice address
2717 ROCK ISLAND PLACE, SUITE 2, BISMARCK, ND 58504-7724
(701) 258-3402
(701) 258-7897
Mailing address
1000 OLD RED TRAIL NW, MANDAN, ND 58554-3052
(701) 663-0012
(701) 663-0522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
552
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461613
—
ND
05
—
60631
—
ND
Enumeration date
07/02/2006
Last updated
10/03/2018
Update your record
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