Healthcare Provider Details

I. General information

NPI: 1770629503
Provider Name (Legal Business Name): TOKARCZYK ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 17TH ST S
VIRGINIA MN
55792-3705
US

IV. Provider business mailing address

229 4TH ST
SIOUX CITY IA
51101-1401
US

V. Phone/Fax

Practice location:
  • Phone: 218-749-8355
  • Fax: 218-749-8356
Mailing address:
  • Phone: 712-252-1519
  • Fax: 712-252-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE TOKARCZYK
Title or Position: PRESIDENT
Credential:
Phone: 712-252-1519