Active NPI
Leidenix PC
- Optometrist
- Mandan, ND
National Provider Identifier
1184057374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 552
- Legal business name
- LEIDENIX PC
- Practice address
- 1000 Old Red Trail NE
Mandan, ND 58554-3052 - Phone
- (701) 663-0012
- Fax
- (701) 663-0522
- NPI assigned
- Aug 12, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Melissa Mattson
- Title
- Manager
- Phone
- (701) 663-0012
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 552 | ND | Primary |
Addresses
Primary practice location
1000 Old Red Trail NE
Mandan, ND 58554-3052
Mailing address
1000 Old Red Trail NE
Mandan, ND 58554-3052
Phone (701) 663-0012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1461915 | Medicaid | ND |
Other names 1
- Bis-Man Eyecare Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060920000515 | ND | Part B Supplier - Clinic/Group Practice | 8527063882 |
Receives reassigned benefits from 3 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mandan, ND; Bismarck, ND |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Bis-Man Eyecare Associates
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Bismarck, ND
- NPI 1063602050
-
- Optometrist
- Bismarck, ND
- NPI 1669401527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376265600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1538524800000",
"number": "1184057374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 OLD RED TRAIL NE",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543052",
"telephone_number": "701-663-0012",
"fax_number": "701-663-0522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 OLD RED TRAIL NE",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543052",
"telephone_number": "701-663-0012",
"fax_number": "701-663-0522"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEIDENIX PC",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-12",
"last_updated": "2018-10-03",
"status": "A",
"authorized_official_last_name": "MATTSON",
"authorized_official_first_name": "MELISSA",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "701-663-0012"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "ND",
"license": "552",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1461915",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bis-Man Eyecare Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mandan, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.