NPIMap

Organization Active NPI

Peter P. Dettlaff P. C.

  • Optometrist
  • Minot, ND
National Provider Identifier
1720105240
Registry record updated Sep 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
399 Issued in ND
Legal business name
PETER P. DETTLAFF P. C.
Practice address
3900 S. Broadway St.
Minot, ND 58701-7534
Phone
(701) 839-8726
Fax
(701) 858-1741
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2007

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

Authorized official

Name
Dr. Peter P. Dettlaff, O.D.
Title
President
Phone
(701) 839-8726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 399 ND Primary

Addresses

Primary practice location

3900 S. Broadway St.
Minot, ND 58701-7534

Mailing address

PO Box 1165
Washburn, ND 58577-1165
Phone (701) 462-8656

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1720105240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1165",
            "city": "WASHBURN",
            "state": "ND",
            "postal_code": "585771165",
            "telephone_number": "701-462-8656",
            "fax_number": "701-858-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 S. BROADWAY ST.",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587017534",
            "telephone_number": "701-839-8726",
            "fax_number": "701-858-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER P. DETTLAFF P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "DETTLAFF",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-839-8726",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.