Healthcare Provider Details

I. General information

NPI: 1225054828
Provider Name (Legal Business Name): STEVE A JEWETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 5TH AVE
BELLE FOURCHE SD
57717-1405
US

IV. Provider business mailing address

1830 5TH AVENUE
BELLE FOURCHE SD
57717-1405
US

V. Phone/Fax

Practice location:
  • Phone: 605-892-4411
  • Fax: 605-892-6227
Mailing address:
  • Phone: 605-892-4411
  • Fax: 605-892-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: