Organization
PRAIRIE VISION CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J WELDER OD (OWNER/ OPTOMETRIST)
(701) 642-4090
Entity
Organization
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
514
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06508001
BCBS ND
ND
01
—
4C632WE
BCBS MN
MN
05
—
60611
—
ND
05
—
749459900
—
MN
01
—
DD0757
RAILROAD MEDICARE
ND
Enumeration date
11/17/2005
Last updated
12/13/2012
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