SANFORD MEDICAL CENTER FARGO (NPI# 1891075198) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891075198 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD SOUTH UNIVERSITY EYE CENTER & OPTICAL |
| Practice Address |
1717 University Dr S Fargo ND 58103-4939 |
| Practice Telephone | 7014615100 |
| Mailing Telephone | 7014615100 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-11-26 |
| Authorized Official Name | MARTHA LECLERC (VICE PRESIDENT) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Sanford South University Eye Center & Optical | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245519081 | Sanford Medical Center Fargo | General Acute Care Hospital | 2990 Seter Parkway, Fargo, ND 58104-8750 | 2011-08-10 |
| 1558458844 | Sanford Medical Center Fargo | Pharmacy | 1720 S University Drive, Fargo, ND 58103-4940 | 2006-10-06 |
| 1578508198 | Sanford Medical Center Fargo | Clinic/Center | 1234 Washington Ave Ste B, Detroit Lakes, MN 56501-3906 | 2006-06-18 |
| 1225635634 | Sanford Medical Center Fargo | Pharmacy | 1720 University Dr S, Fargo, ND 58103-4940 | 2020-10-08 |
| 1174120281 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-10-02 |
| 1013559905 | Sanford Medical Center Fargo | Hospice Care, Community Based | 801 Broadway N, Fargo, ND 58102-3641 | 2019-10-11 |
| 1366092801 | Sanford Medical Center Fargo | Hospice Care, Community Based | 820 4th St N, Fargo, ND 58102-4539 | 2019-09-17 |
| 1861927709 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104 | 2017-04-28 |
| 1801151394 | Sanford Medical Center Fargo | Clinic/Center | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-07-10 |
| 1366717118 | Sanford Medical Center Fargo | Clinic/Center | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2012-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SANFORD MEDICAL CENTER FARGO | 720 N 4th St, Fargo, ND 58122-4520 |
| Street Address |
1717 UNIVERSITY DR S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-4939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659373876 | Jennifer R. Olbum | Ophthalmology | 1717 University Dr S, Fargo, ND 58103-4939 | 2005-06-01 |
| 1750949855 | Chelsea Marie Norman | Physician Assistant | 1717 University Dr S, Fargo, ND 58103-4939 | 2019-06-03 |
| 1245726363 | Anna Pauline Wilson | Nurse Practitioner | 1717 University Dr S, Fargo, ND 58103-4939 | 2018-07-02 |
| 1598262545 | Leann Elizabeth Czapiewski | Dietitian, Registered | 1717 University Dr S, Fargo, ND 58103-4939 | 2018-04-06 |
| 1881063006 | Meagen Anderson | Physician Assistant | 1717 University Dr S, Fargo, ND 58103-4939 | 2015-09-17 |
| 1972938843 | Amber D Strobel | Nurse Practitioner | 1717 University Dr S, Fargo, ND 58103-4939 | 2013-09-10 |
| 1750632352 | Brianna Srnsky | Dietitian, Registered | 1717 University Dr S, Fargo, ND 58103-4939 | 2012-09-24 |
| 1790060846 | Alison Rae Moses | Optometrist | 1717 University Dr S, Fargo, ND 58103-4939 | 2011-10-19 |
| 1215211750 | Kelsey R Herrick | Dietitian, Registered | 1717 University Dr S, Fargo, ND 58103-4939 | 2011-10-03 |
| 1588962781 | William J Boggess | Oral & Maxillofacial Surgery | 1717 University Dr S, Fargo, ND 58103-4939 | 2011-03-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
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| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447879663 | Lumen Vision PC | Optometrist | 5120 Prosperity Way S Ste 114, Fargo, ND 58104-7568 | 2020-04-09 |
| 1376194472 | Vanessa Manlove | Optometrist | 1902 25th Ave S, Fargo, ND 58103-5128 | 2019-09-20 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1720447808 | Eyes On Broadway LLC | Optometrist | 311 Broadway N, Fargo, ND 58102-4714 | 2016-02-17 |
| 1386028777 | Carissa Guler | Optometrist | 3902 13th Ave S Ste 256, Fargo, ND 58103-3357 | 2015-07-15 |
| 1306139266 | Stacey Archibald | Optometrist | 3409 45th St S Ste 100, Fargo, ND 58104-8970 | 2011-05-25 |
| 1407187065 | Selina Bjorlie | Optometrist | 2826 Lilac Ln N, Fargo, ND 58102-1703 | 2010-01-21 |
| 1073840336 | Kristin F Engstrom, O.d. PC | Optometrist | 3757 55th Ave S, Fargo, ND 58104 | 2009-11-06 |
| 1679808752 | Erin L Barrett | Optometrist | 3265 45th St S Ste 104, Fargo, ND 58104-7930 | 2009-10-07 |
| 1235326398 | Dr. L.r. Masciarelli & Associates Optometry | Optometrist | 4302 13th Ave S, Fargo, ND 58103-3395 | 2007-10-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.