NPIMap

Organization Active NPI

Williston Basin Eyecare Associates, P.C.

  • Optometrist
  • Williston, ND
National Provider Identifier
1225323504
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
574 Issued in ND
Legal business name
WILLISTON BASIN EYECARE ASSOCIATES, P.C.
Practice address
1213 15TH Ave W
Williston, ND 58801-3800
Phone
(701) 577-3937
NPI assigned
Jun 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Laurali M Sime, ODNPI 1851465223
Title
Vice President
Phone
(701) 577-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 574 ND Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 684 ND
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 596 ND
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 438 ND
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 590 ND

Addresses

Primary practice location

1213 15TH Ave W
Williston, ND 58801-3800

Mailing address

1213 15TH Ave W
Williston, ND 58801-3800
Phone (701) 577-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110722000011 ND Part B Supplier - Clinic/Group Practice 4183892995 Receives reassigned benefits from 7 practitioners
Practice locations: Williston, ND
O20111027000515 ND DME Supplier - Physician - Optometrist 4183892995 Practice locations: Williston, ND

National Provider Directory

National Provider Directory

Locations

1213 15th Ave W
Ste 260
Williston, ND 58801
Phone (701) 572-7641

1500 14th St W
Ste 100
Williston, ND 58801
Phone (701) 577-3937

Interoperability endpoints

  • Direct secure messaging: dbrenno@willistonbasineyecare.eyefinity-direct.com
  • Direct secure messaging: mtofte@willistonbasineyecare.eyefinity-direct.com
  • Direct secure messaging: aanderson@willistonbasineyecare.eyefinity-direct.com
  • Direct secure messaging: mfearing@willistonbasineyecare.eyefinity-direct.com
  • Direct secure messaging: rrasmussen@willistonbasineyecare.eyefinity-direct.com
  • Direct secure messaging: lsime@willistonbasineyecare.eyefinity-direct.com

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1225323504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013800",
            "telephone_number": "701-577-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013800",
            "telephone_number": "701-577-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLISTON BASIN EYECARE ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "SIME",
        "authorized_official_first_name": "LAURALI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "701-577-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "574",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "684",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "596",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "438",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "590",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.

Verify at the official NPI Registry.