Individual
MARK ELLIOT ANDRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
221 MAIN STREET NORTH, CROSBY, ND 58730-0261
(701) 965-6590
(701) 965-6591
Mailing address
221 MAIN STREET NORTH, P.O. BOX 261, CROSBY, ND 58730-0261
(701) 965-6590
(701) 965-6591
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
374
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0482069
—
MT
05
—
060229
—
ND
05
—
060266
—
ND
Enumeration date
01/30/2007
Last updated
07/30/2008
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