MEDICARE: OUTPOST OPTICAL INC

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	0547	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0005536	OTHER	SD	BLUE CROSS BLUE SHIELD
3	20033	OTHER		SPECTERA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	29577	OTHER		AVESIS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538309604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPOST OPTICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 1993
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-1993
Country	:	US
Telephone Number	:	605-232-3937
Fax Number	:	605-235-1350

Provider Business Practice Location Address
First Line	:	206 MILITARY RD
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-3170
Country	:	US
Telephone Number	:	605-232-3937
Fax Number	:	605-235-1350

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JEFF B RABBITT
Credential	:
Telephone Number	:	605-232-3937

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	04/08/2014

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Directions to “OUTPOST OPTICAL INC ” Practice Location

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