MEDICARE: NORTHERN HILLS EYE CARE, PROF. L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	472	SD

General Provider Information

NPI Number	:	1356395156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN HILLS EYE CARE, PROF. L.L.C.

Provider Business Mailing Address
First Line	:	910 HARMON ST
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2556
Country	:	US
Telephone Number	:	605-347-2666
Fax Number	:	605-347-5823

Provider Business Practice Location Address
First Line	:	910 HARMON ST
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2556
Country	:	US
Telephone Number	:	605-347-2666
Fax Number	:	605-347-5823

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHARON PETERSON
Credential	:
Telephone Number	:	605-347-2666

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/02/2022

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