NPIMap

Organization Active NPI

Eyecare Associates, PC

  • Optometrist
  • Fargo, ND
National Provider Identifier
1811077100
Registry record updated Dec 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
360
Legal business name
EYECARE ASSOCIATES, PC
Practice address
3902 13TH Ave S
Fargo, ND 58103-3357
Phone
(701) 282-5880
Fax
(701) 282-8414
NPI assigned
Oct 17, 2006
Last updated
Dec 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2007

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

Authorized official

Name
Dr. Kevin Lyle Melicher, ODNPI 1144257965
Title
President
Phone
(701) 282-5880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 360 Primary

Addresses

Primary practice location

3902 13TH Ave S
Fargo, ND 58103-3357

Mailing address

3902 13TH Ave SW
Fargo, ND 58103-3357
Phone (701) 282-5880

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000501 ND Part B Supplier - Clinic/Group Practice 0648239301 Receives reassigned benefits from 5 practitioners
Practice locations: Fargo, ND
O20100930094439 ND DME Supplier - Physician - Optometrist 0648239301 Practice locations: Fargo, ND

National Provider Directory

National Provider Directory

Locations

3902 13th Ave S
Ste 2517
Fargo, ND 58103
Phone (701) 282-5880

4360 13th Ave S
Fargo, ND 58103
Phone (701) 282-5880

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197504000000",
    "number": "1811077100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 13TH AVE SW",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033357",
            "telephone_number": "701-282-5880",
            "fax_number": "701-282-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033357",
            "telephone_number": "701-282-5880",
            "fax_number": "701-282-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-12-13",
        "status": "A",
        "authorized_official_last_name": "MELICHER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-282-5880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; 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.