Provider Demographics
NPI:1043489925
Name:PRZYMUS, DAVID CHARLES (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:PRZYMUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 3RD AVE W
Mailing Address - Street 2:PO BOX 967
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4940
Mailing Address - Country:US
Mailing Address - Phone:701-225-2020
Mailing Address - Fax:
Practice Address - Street 1:446 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4940
Practice Address - Country:US
Practice Address - Phone:701-225-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND70782OtherMEDICARE
ND893210OtherND VISION
NDCN8225OtherMEDICARE RAILRAOD
ND60677Medicaid
NDCN8225OtherMEDICARE RAILRAOD