Eyes on Broadway LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYES ON BROADWAY LLC

Practice address

311 Broadway N
Fargo, ND 58102-4714

Phone

(701) 356-3937

NPI assigned

Feb 17, 2016

Organization subpart

No

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

Authorized official

Name

Mark Tufte, OD

Title

Optometry

Phone

(701) 356-3937

Specialties & licenses 1

Addresses

Locations

Practitioners 4

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

• Stacey Archibald, B.SC., O.D.

  • Optometrist
  • Fargo, ND
  • NPI 1306139266
  NPD (past)
• Gary E Johnson, OD

  • Corneal and Contact Management Optometrist
  • Fargo, ND
  • NPI 1275551848
  NPD (past)
• Krystal L. Long, O.D.

  • Optometrist
  • Fargo, ND
  • NPI 1942555974
  NPD (past)
• Thomas James Rene, OD

  • Optometrist
  • Fargo, ND
  • NPI 1386895290
  NPD (past)

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455667200000",
    "number": "1720447808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024714",
            "telephone_number": "701-356-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYES ON BROADWAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A",
        "authorized_official_last_name": "TUFTE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OPTOMETRY",
        "authorized_official_telephone_number": "701-356-3937",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Consultants of Fargo, PLLC
• Eye Physicians Group LLC
• Eyecare Associates, PC
• Eyemart Express LLC
• Eyemart Express LTD
• Shankar Ezom
• F5 Project
• Kevin Michael Faber, MD
• Face and Jaw Surgeons PC
• Jennifer Faehnrich, M.S.,CCC-SLP

• All providers in Fargo, ND
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.