Basic Information
| Provider Information | |||||||||
| NPI: | 1033134374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METZGER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 541 | ND | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | ND200104 | 01 | ND | LHS # | OTHER | 15682 | 01 | ND | NDBS # | OTHER | 2201200 | 01 | ND | MEDICA # | OTHER | 2201201 | 01 | ND | MEDICA # | OTHER | 880541 | 01 | ND | ND VISION # | OTHER | 162224200 | 05 | ND | MEDICAID | 59D22ME | 01 | ND | MNBS # | OTHER | 60483 | 05 | ND | MEDICAID | HP25716 | 01 | ND | HEALTHPARTNERS # | OTHER | MM0448224 | 01 | ND | DEA # | OTHER | 142963 | 01 | ND | UCARE # | OTHER | 2201509 | 01 | ND | MEDICA # | OTHER | DA9011026982 | 01 | ND | PREFERRED ONE # | OTHER | 52Q77ME | 01 | ND | MNBS # | OTHER | 890541 | 01 | ND | ND VISION # | OTHER | 905897 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER |