Healthcare Provider Details

I. General information

NPI: 1962333559
Provider Name (Legal Business Name): VICTORIA LANDMARK ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 6TH ST
BROOKINGS SD
57006-1731
US

IV. Provider business mailing address

2233 6TH ST
BROOKINGS SD
57006-1731
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-3550
  • Fax: 605-692-4475
Mailing address:
  • Phone: 605-692-3550
  • Fax: 605-692-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number267776
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: