Individual
DR. WYMAN A JORGENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
315 11TH ST N, SUITE A, WAHPETON, ND 58075-4101
(701) 642-4090
(701) 642-9424
Mailing address
315 11TH ST N, SUITE A, WAHPETON, ND 58075-4101
(701) 642-4090
(701) 642-9424
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ND0336
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2203146
MEDICA
MN
01
—
25387
BCBS ND
ND
05
—
364223200
—
MN
05
—
60152
—
ND
01
—
624891045681
PREFERRED ONE
ND
01
—
84M91JO
BCBS MN
MN
01
—
P00215724
RAILROAD MEDICARE
ND
Enumeration date
07/14/2006
Last updated
06/16/2008
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