NPIMap

Organization Active NPI

Leidenix PC

Doing business as Bis-Man Eyecare Associates

  • Optometrist
  • Bismarck, ND
National Provider Identifier
1669401527
Registry record updated Oct 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
552 Issued in ND
Legal business name
LEIDENIX PC
Doing business as
Bis-Man Eyecare Associates
Practice address
2717 Rock Island Place
Suite 2
Bismarck, ND 58504-7724
Phone
(701) 258-3402
Fax
(701) 258-7897
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2018

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)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 552 ND Primary

Addresses

Primary practice location

2717 Rock Island Place
Suite 2
Bismarck, ND 58504-7724

Mailing address

1000 Old Red Trail NW
Mandan, ND 58554-3052
Phone (701) 663-0012

Other identifiers 2

IdentifierTypeStateIssuer
1461613MedicaidND
60631MedicaidND

Other names 1

  • Bis-Man Eyecare Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060920000515 ND Part B Supplier - Clinic/Group Practice 8527063882 Receives reassigned benefits from 3 practitioners
2 other NPIs on this 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 Associates3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1000 Old Red Trl NW
Mandan, ND 58554
Phone (701) 663-0012

Practitioners & affiliated clinicians

Practitioners 3

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": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1669401527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OLD RED TRAIL NW",
            "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": "2717 ROCK ISLAND PLACE",
            "address_2": "SUITE 2",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585047724",
            "telephone_number": "701-258-3402",
            "fax_number": "701-258-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEIDENIX PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1461613",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60631",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bis-Man Eyecare Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.

Verify at the official NPI Registry.