Organization
ROLLA EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ALAN THORMAN OD (DOCTOR/OWNER)
(701) 477-5656
Entity
Organization
Contact information
Practice address
118 3RD ST. NE, ROLLA, ND 58367-1170
(701) 477-5656
(701) 477-5675
Mailing address
PO BOX 1170, ROLLA, ND 58367-1170
(701) 477-5656
(701) 477-5675
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
540
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410048131
MEDICARE RAIL ROAD
ND
05
—
60650
—
ND
01
—
B48107221235
PREFERRED
ND
01
—
THO13533
BCBS
ND
Enumeration date
02/05/2008
Last updated
03/04/2009
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