NPIMap

Organization Active NPI

Bismarck Eyecare, P.C.

  • Optometrist
  • Bismarck, ND
National Provider Identifier
1396988010
Registry record updated Apr 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
591 Issued in ND
Legal business name
BISMARCK EYECARE, P.C.
Practice address
1830 E Century Ave
Suite 1
Bismarck, ND 58503-0639
Phone
(701) 222-1140
Fax
(701) 222-1142
NPI assigned
Apr 10, 2009
Last updated
Apr 10, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2009

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

Authorized official

Name
Nichol K Dillavou, O.D.NPI 1558470401
Title
President
Phone
(701) 222-1140

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 591 ND Primary

Addresses

Primary practice location

1830 E Century Ave
Suite 1
Bismarck, ND 58503-0639

Mailing address

1623 E Blossom Dr
Menoken, ND 58558-5018
Phone (701) 222-1140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000614 ND Part B Supplier - Clinic/Group Practice 7719039551 Receives reassigned benefits from 1 practitioner
Practice locations: Bismarck, ND; Jamestown, ND

National Provider Directory

National Provider Directory

Locations

2222 E Broadway Ave
Bismarck, ND 58501
Phone (701) 222-1140

921 25th St SW
Jamestown, ND 58401
Phone (701) 252-1860

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239321600000",
    "number": "1396988010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 E BLOSSOM DR",
            "city": "MENOKEN",
            "state": "ND",
            "postal_code": "585585018",
            "telephone_number": "701-222-1140",
            "fax_number": "701-222-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 E CENTURY AVE",
            "address_2": "SUITE 1",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585030639",
            "telephone_number": "701-222-1140",
            "fax_number": "701-222-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISMARCK EYECARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-10",
        "last_updated": "2009-04-10",
        "status": "A",
        "authorized_official_last_name": "DILLAVOU",
        "authorized_official_first_name": "NICHOL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-222-1140",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; 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.