Provider Demographics
NPI:1447635065
Name:ADVANCED LOOKS EYE CARE PC
Entity type:Organization
Organization Name:ADVANCED LOOKS EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:971-404-7853
Mailing Address - Street 1:1100 N BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1349
Mailing Address - Country:US
Mailing Address - Phone:701-852-2020
Mailing Address - Fax:701-852-7853
Practice Address - Street 1:1100 N BROADWAY STE 110
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1349
Practice Address - Country:US
Practice Address - Phone:701-852-2020
Practice Address - Fax:701-852-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty