Provider Demographics
NPI:1447348602
Name:FERCHO CATARACT & EYE CLINIC, INC.
Entity type:Organization
Organization Name:FERCHO CATARACT & EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-0561
Mailing Address - Street 1:100 4TH ST S STE 612
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1940
Mailing Address - Country:US
Mailing Address - Phone:701-235-0561
Mailing Address - Fax:701-235-0330
Practice Address - Street 1:100 4TH ST S STE 612
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1940
Practice Address - Country:US
Practice Address - Phone:701-235-0561
Practice Address - Fax:701-235-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00488001OtherBLUE SHIELD
MN064813200Medicaid
MN2M015FEOtherBLUE SHIELD
ND00840001OtherVISION SERVICES
ND17403Medicaid
ND70381Medicare ID - Type Unspecified
ND17403Medicaid
ND0209560001Medicare NSC
MNC02405Medicare ID - Type Unspecified